1
|
Huang J, Chen X, Xie X, Song L, Chen L, Lan X, Bai X, Chen X, Du C. The efficiency and safety of low-dose apatinib combined with oral vinorelbine in pretreated HER2-negative metastatic breast cancer. Cancer Med 2024; 13:e7181. [PMID: 38659376 PMCID: PMC11043681 DOI: 10.1002/cam4.7181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/17/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Apatinib is an oral small-molecule tyrosine kinase inhibitor that blocks vascular endothelial growth factor receptor-2. Oral vinorelbine is a semisynthetic chemotherapeutic agent of vinorelbine alkaloids. Apatinib and oral vinorelbine have been proved to be effective in the treatment of metastatic breast cancer (mBC). At present, several small sample clinical trials have explored the efficacy of apatinib combined with oral vinorelbine in the treatment of mBC. METHODS This retrospective study included 100 human epidermal growth factor receptor-2 (HER2)-negative mBC patients who received low-dose apatinib (250 mg orally per day) plus oral vinorelbine until disease progression or intolerance during February 2017 and March 2023. The progression-free survival (PFS), overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR), disease control rate (DCR), and safety were analyzed by SPSS 26.0 software and GraphPad Prism 8 software. Cox proportional hazards regression model for univariate and multivariate was used to identify factors significantly related to PFS and OS. RESULTS The median follow-up time for this study was 38.1 months. Among 100 patients with HER2-negative mBC, 66 were hormone receptor (HR)-positive/HER2-negative and 34 were triple-negative breast cancer (TNBC). The median PFS and OS were 6.0 months (95% CI, 5.2-6.8 months) and 23.0 months (95% CI, 19.9-26.1 months). There were no statistical differences in PFS (p = 0.239) and OS (p = 0.762) between the HR-positive /HER2-negative and TNBC subgroups. The ORR, CBR, and DCR were 21.0%, 58.0%, and 78.0%, respectively. Ninety-five patients (95.0%) experienced varying grades of adverse events (AEs) and 38.0% of patients for Grades 3-4. The most common Grades 3-4 AEs that we observed were neutropenia (30.0%) and leukopenia (25.0%). CONCLUSION Low-dose apatinib combined with oral vinorelbine demonstrates potential efficacy and well tolerated for pretreated HER2-negative mBC.
Collapse
Affiliation(s)
- Jia‐Yi Huang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Xue‐Lian Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Xiao‐Feng Xie
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Lin Song
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Li‐Ping Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Xiao‐Feng Lan
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Xue Bai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Xiao Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| | - Cai‐Wen Du
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhen518116GuangdongChina
| |
Collapse
|
2
|
Vinorelbine after prior treatment with eribulin for advanced breast cancer: A single-centre experience suggesting cross-resistance. Clin Breast Cancer 2022; 22:e825-e831. [DOI: 10.1016/j.clbc.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
|
3
|
Brems-Eskildsen AS, Linnet S, Danø H, Luczak A, Vestlev PM, Jakobsen EH, Neimann J, Jensen CB, Dongsgaard T, Langkjer ST. Metronomic treatment of vinorelbine with oral capecitabine is tolerable in the randomized Phase 2 study XeNa including patients with HER2 non-amplified metastatic breast cancer. Acta Oncol 2021; 60:157-164. [PMID: 33259244 DOI: 10.1080/0284186x.2020.1851045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metronomic treatment is hypothesized to be less toxic and more effective as compared to standard maximal tolerable dosing treatment in metastatic cancer disease. MATERIAL AND METHODS We tested the metronomic treatment principle with vinorelbine in a randomized phase 2 setting combined with standard capecitabine treatment in the XeNa trial with Clinical Trials.gov identifier number: NCT0141771. 120 patients with disseminated HER2 non-amplified breast cancer were included. Randomization was between Arm A: vinorelbine 60 mg/m2 day 1 + day 8 in the first cycle followed by 80 mg/m2 day 1 + day 8 in the following cycles or Arm B: vinorelbine 50 mg three times a week. Capecitabine 1000 mg/m2 twice a day for days 1-14 was administered in both arms. RESULTS The treatment was generally well-tolerated. The response rate (RR) was 24% (arm A) versus 29% (arm B) (p = .67). The clinical benefit rate (CBR) 46.8% (arm A) versus 51.7% (arm B) (p = .72). We found a median progression-free survival (PFS) of 7.1 months (95% confidence interval [CI] 3.9-10.3) in arm A and 6.3 months (95% CI 4.1-8.5) in arm B (p = .25) whereas median overall survival (OS) was 23.3 months (95% CI 20.2-26.4) in arm A and 22.3 months (95% CI 14.3-30.3) in arm B (p = .76). CONCLUSIONS We confirmed that the combination of vinorelbine and capecitabine was well tolerated. Metronomic treatment can be used with acceptable adverse events (AEs), but we did not find significant difference in the effect compared to the standard treatment.
Collapse
Affiliation(s)
| | - Søren Linnet
- Department of Oncology, Region Hospital of West Jutland, Herning, Denmark
| | - Hella Danø
- Department of Oncology, Region Hospital in Hilleroed, Hillerod, Denmark
| | - Adam Luczak
- Department of Oncology, University Hospital of Aalborg, Aalborg, Denmark
| | | | | | - Jeppe Neimann
- Department of Oncology, University Hospital of Aarhus, Aarhus, Denmark
| | | | - Trine Dongsgaard
- Department of Oncology, Region Hospital of West Jutland, Herning, Denmark
| | | |
Collapse
|
4
|
Sgroi V, Bassanelli M, Roberto M, Iannicelli E, Porrini R, Pellegrini P, Tafuri A, Marchetti P. Complete response in advanced breast cancer patient treated with a combination of capecitabine, oral vinorelbine and dasatinib. Exp Hematol Oncol 2018; 7:2. [PMID: 29416938 PMCID: PMC5784669 DOI: 10.1186/s40164-018-0094-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Currently, there are no data available on the best choice of treatment in heavily pretreated patients with advanced breast cancer. However, the combination of oral vinorelbine and capecitabine has been demonstrated to be effective and safe in patients with advanced breast cancer pretreated with anthracycline. Furthermore, some studies assessed the activity of dasatinib, an oral tyrosine kinase inhibitor that inhibits five oncogenic tyrosine kinase families, alone or in combination with different chemotherapy in patients affected with advanced breast cancer. Case presentation A patient with metastatic breast cancer, hormone receptor positive and human epidermal grow factor receptor 2 negative, pretreated with epirubicine, taxanes and nab-paclitaxel, was submitted to third line chemotherapy with vinorelbine 60 mg/m2 on day 1, 8 plus capecitabine 1000 mg/m2 twice daily from day 1 to day 14 every 21 days. The patient was taking also dasatinib 100 mg once daily for chronic myeloid leukemia. The treatment was well tolerated and, after 15 months, computed tomography scan showed a complete response of liver metastases and bone stable disease. After another 28 months, a 18-fluorodeoxyglucose positron emission tomography scan showed a metabolic response of bone metastases without other site of disease. Conclusions This is the first case in literature about activity of dasatinib in combination with a chemotherapy schedule of oral vinorelbine and capecitabine in advanced breast cancer. This treatment showed both good tolerability and great activity with a long progression free survival of 54 months.
Collapse
Affiliation(s)
- V Sgroi
- 1Department of Molecular and Clinical Medicine, Medical Oncology Unit, "Sapienza" University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - M Bassanelli
- 1Department of Molecular and Clinical Medicine, Medical Oncology Unit, "Sapienza" University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - M Roberto
- 1Department of Molecular and Clinical Medicine, Medical Oncology Unit, "Sapienza" University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - E Iannicelli
- 2Department of Radiology, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - R Porrini
- 3Department of Molecular and Clinical Medicine, Hematology,, "Sapienza" University of Rome, Rome, Italy
| | - P Pellegrini
- 1Department of Molecular and Clinical Medicine, Medical Oncology Unit, "Sapienza" University of Rome, Sant' Andrea Hospital, Rome, Italy
| | - A Tafuri
- 3Department of Molecular and Clinical Medicine, Hematology,, "Sapienza" University of Rome, Rome, Italy
| | - P Marchetti
- 1Department of Molecular and Clinical Medicine, Medical Oncology Unit, "Sapienza" University of Rome, Sant' Andrea Hospital, Rome, Italy
| |
Collapse
|
5
|
Ting CH, Chen YC, Wu CJ, Chen JY. Targeting FOSB with a cationic antimicrobial peptide, TP4, for treatment of triple-negative breast cancer. Oncotarget 2018; 7:40329-40347. [PMID: 27248170 PMCID: PMC5130011 DOI: 10.18632/oncotarget.9612] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/02/2016] [Indexed: 12/31/2022] Open
Abstract
Triple-negative breast cancer (TNBC) currently lacks a suitable therapeutic candidate and is thus difficult to treat. Here, we report that a cationic antimicrobial peptide (CAP), tilapia piscidin 4 (TP4), which was derived from Nile tilapia (Oreochromis niloticus), is selectively toxic to TNBC. TP4 acts by inducing an AP-1 protein called FOSB, the expression of which is negatively associated with the pathological grade of TNBC. We show that TP4 is bound to the mitochondria where it disrupts calcium homeostasis and activates FOSB. FOSB overexpression results in TNBC cell death, whereas inhibition of calcium signaling eliminates FOSB induction and blocks TP4-induced TNBC cell death. Both TP4 and anthracyclines strongly induced FOSB, particularly in TNBC, indicating that FOSB may be suitable as a biomarker of drug responses. This study thus provides a novel therapeutic approach toward TNBC through FOSB induction.
Collapse
Affiliation(s)
- Chen-Hung Ting
- Marine Research Station, Institute of Cellular and Organismic Biology, Academia Sinica, Jiaushi, Ilan 262, Taiwan
| | - Yi-Chun Chen
- Marine Research Station, Institute of Cellular and Organismic Biology, Academia Sinica, Jiaushi, Ilan 262, Taiwan
| | - Chang-Jer Wu
- Department of Food Science, National Taiwan Ocean University, Keelung 202, Taiwan
| | - Jyh-Yih Chen
- Marine Research Station, Institute of Cellular and Organismic Biology, Academia Sinica, Jiaushi, Ilan 262, Taiwan
| |
Collapse
|
6
|
Petrelli F, Di Cosimo S, Lonati V, Barni S. Vinorelbine With Capecitabine, an Evergreen Doublet for Advanced Breast Cancer: A Systematic Literature Review and Pooled-Analysis of Phase II-III Studies. Clin Breast Cancer 2016; 16:327-334. [PMID: 27282844 DOI: 10.1016/j.clbc.2016.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/24/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
Abstract
Metastatic breast cancer (MBC) is treated with cytotoxic drugs or endocrine agents according to the site and extent of the disease, biology, previous treatments, and the patient's condition, comorbidities, and wishes. In MBC, vinorelbine (VRB) and capecitabine (X; VRB + X) are chemotherapy drugs that hold activity as first or later lines of therapy. We conducted a systematic literature review and meta-analysis to quantify the efficacy of the VRB + X combination in HER2-negative (HER2-) MBC. We searched PubMed, EMBASE, SCOPUS, Web of Science, the Cochrane Library, and CINAHL for phase II/III clinical trials that assessed VRB + X for patients with HER2- MBC. Pooled estimates of the overall response rate (RR), median progression-free survival (PFS), and overall survival (OS) were computed using random or fixed effects models. Twenty-seven studies were included in the analysis, encompassing a total of 1356 MBC patients. All were phase II (n = 21) or prospective/pilot (n = 5) trials, except for 1 that was a phase III controlled trial. The pooled estimate for the RR in first-line therapy (n = 16 trials) was 52.9% (95% confidence interval [CI], 46.5%-59.2%). For second-line trials, data were available in n = 9 studies and the overall RR was 41% (95% CI, 31.2%-51.6%). The pooled estimates for median PFS and OS in first-line therapy were 7.3 (95% CI, 6.2-8.3) and 22.3 (95% CI, 20-24.5) months, respectively. Vinorelbine + X, with the dose and schedules currently used in clinical practice, appears to be an effective and feasible chemotherapy for MBC, for first- and also for second-line therapy.
Collapse
Affiliation(s)
- Fausto Petrelli
- Department of Oncology, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
| | - Serena Di Cosimo
- Department of Medical Oncology, Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Lonati
- Department of Oncology, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy
| | - Sandro Barni
- Department of Oncology, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy
| |
Collapse
|
7
|
Lv H, Yan M, Zhang M, Niu L, Zeng H, Cui S. Efficacy of capecitabine-based combination therapy and single-agent capecitabine maintenance therapy in patients with metastatic breast cancer. Chin J Cancer Res 2015; 26:692-7. [PMID: 25561767 DOI: 10.3978/j.issn.1000-9604.2014.12.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/10/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to observe the efficacy and toxicities of capecitabine-based chemotherapy and capecitabine monotherapy as maintenance therapy in the treatment of metastatic breast cancer (MBC). PATIENTS AND METHODS A total of 98 MBC patients were treated with capecitabine combined with vinorelbine (NX). RESULTS The median number of treatment was 6 cycles (1-7 cycles). There were two cases of complete remission (CR), 58 partial remission, 27 stable disease (SD), 11 progression disease. The overall response rate (ORR) (CR + PR) was 61.2%. The clinical benefit rate (CBR) was 75.5%. Fifty of effective patients received with capecitabine monotherapy as maintenance therapy. The ORR (CR + PR) was 4%. The CBR was 48%. The median progression-free survival (PFS) was 12 months. In maintenance therapy or not, the median post metastasis survival rate (MSR) was 63 and 28 months, respectively. In the combination therapy group, the major grade 3/4 toxicities included hand-foot syndrome (3.1%), skin pigmentation (2.0%), diarrhoea and abdominal distension (5.1%), stomatitis (1.0%), and leukopenia (20.4%). CONCLUSIONS Capecitabine-based combination therapy and single-agent capecitabine maintenance therapy were well tolerated and effective to MBC.
Collapse
Affiliation(s)
- Huimin Lv
- Breast Disease Center, Henan Cancer Hospital & Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Min Yan
- Breast Disease Center, Henan Cancer Hospital & Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Mengwei Zhang
- Breast Disease Center, Henan Cancer Hospital & Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Limin Niu
- Breast Disease Center, Henan Cancer Hospital & Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Huiai Zeng
- Breast Disease Center, Henan Cancer Hospital & Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou 450008, China
| | - Shude Cui
- Breast Disease Center, Henan Cancer Hospital & Affiliated Cancer Hospital, Zhengzhou University, Zhengzhou 450008, China
| |
Collapse
|
8
|
Efficacy and Safety of the All-Oral Schedule of Metronomic Vinorelbine and Capecitabine in Locally Advanced or Metastatic Breast Cancer Patients: The Phase I-II VICTOR-1 Study. Int J Breast Cancer 2014; 2014:769790. [PMID: 24551455 PMCID: PMC3914392 DOI: 10.1155/2014/769790] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/25/2022] Open
Abstract
Background. Vinorelbine (VRB) and capecitabine (CAPE) are demonstrated to be active in pretreated metastatic breast cancer patients. Different studies have demonstrated that the metronomic treatment is active with an acceptable toxicity profile. We designed a Phases I-II study to define the MTD of oral metronomic, VRB, and CAPE. Patients and Methods. Phase I: fixed dose of CAPE was 500 mg thrice a day, continuously. Level I of VRB was 20 mg/tot thrice a week for 3 weeks (1 cycle). Subsequent levels were 30 mg/tot and 40 mg/tot (Level III), respectively, if no Grades 3-4 toxicity were observed in the previous level. Phase II: further 32 patients received the MTD of VRB plus CAPE for a total of 187 cycles to confirm toxicity profile. Results. 12 patients were enrolled in Phase I and 22 in Phase II. Phase I: the MTD of VRB was 40 mg. Phase II: 187 cycles were delivered, observing 5.9% of Grades 3-4 toxicity. 31 patients are evaluable for efficacy, obtaining a clinical benefit rate of 58.1%. Conclusion. MTD of VRB with fixed dose of CAPE was 40 mg thrice a week and was the recommended dose for the ongoing Phase II multicenter study.
Collapse
|
9
|
André F, Zielinski CC. Optimal strategies for the treatment of metastatic triple-negative breast cancer with currently approved agents. Ann Oncol 2013; 23 Suppl 6:vi46-51. [PMID: 23012302 DOI: 10.1093/annonc/mds195] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is an aggressive histological subtype with limited treatment options and very poor prognosis following progression after standard chemotherapeutic regimens. Resistance to current standard therapies such as anthracyclines or taxanes limits the available options for previously treated patients with metastatic TNBC to a small number of non-cross-resistant regimens, and there is currently no preferred standard chemotherapy. Duration of response is usually short, with rapid relapse very common and median survival of just 13 months. The newly approved agent eribulin has shown a survival benefit in patients who had previously been treated with anthracycline- or taxane-containing regimens, including in patients with TNBC. Platinum-based regimens are an emerging option for patients with BRCA1 mutation, and newer targeted agents such as anti-angiogenic treatment with bevacizumab or anti-epidermal growth factor receptor treatment with cetuximab, have shown some benefit in combination therapy. However, there remains an urgent unmet need for improved targeted agents for this patient population. Improved treatment may be facilitated by biomarker-led understanding of subgroup molecular targets, which may predict benefit from currently approved agents, as well as newer targeted drugs.
Collapse
Affiliation(s)
- F André
- Department of Medical Oncology and INSERM U981, Institut Gustave Roussy, Villejuif, France.
| | | |
Collapse
|
10
|
Bayraktar S, Glück S. Molecularly targeted therapies for metastatic triple-negative breast cancer. Breast Cancer Res Treat 2013; 138:21-35. [PMID: 23358903 DOI: 10.1007/s10549-013-2421-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/15/2013] [Indexed: 12/11/2022]
Abstract
Triple-negative breast cancer (TNBC) refers to a heterogeneous group of tumors that do not express the estrogen/progesterone-receptor (ER/PR), and human epidermal growth factor receptor-2 (HER2). TNBC is an aggressive histological subtype with limited treatment options and very poor prognosis following progression after standard chemotherapy regimens. There have been significant improvements in the outcome of other subtypes of breast cancer, including ER-positive/HER2 overexpressed tumors, attributed to the addition of targeted therapy, including hormonal agents and trastuzumab. However, no specific targeted agents are currently available for the treatment of TNBC. This review aims to collate and describe the most recent data on targeted therapies that have demonstrated efficacy in the management of metastatic TNBC. Targeted agents that have been investigated in the treatment of metastatic TNBC include inhibitors of poly(ADP-ribose) polymerase, angiogenesis, mammalian target of rapamycin, epidermal growth factor receptor, HDAC, Jak2, and Src. Several of these agents have shown considerable promise.
Collapse
Affiliation(s)
- Soley Bayraktar
- Department of Medical Oncology, Mercy Cancer Center, Ardmore, OK, USA.
| | | |
Collapse
|
11
|
Tawfik H, Rostom Y, Elghazaly H. All-oral combination of vinorelbine and capecitabine as first-line treatment in HER2/Neu-negative metastatic breast cancer. Cancer Chemother Pharmacol 2013; 71:913-9. [PMID: 23344713 DOI: 10.1007/s00280-013-2082-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/08/2013] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of an all-oral vinorelbine and capecitabine combination therapy in anthracycline- ± taxane-pretreated HER2/Neu-negative metastatic breast cancer (MBC). METHODS A phase 2 trial including women >18 years with HER2/Neu-negative MBC previously exposed to anthracycline- ± taxane-based chemotherapy in the adjuvant or neoadjuvant setting. Enrolled patients received oral vinorelbine 60 mg/m(2) on days 1 and 8 and oral capecitabine 1,000 mg/m(2) twice daily on days 1-14 on a 3 weekly schedule. Patients with progressive disease after 3 cycles discontinued the study, while the remaining patients continued treatment for a maximum of 6 cycles. RESULTS From January 2007 to March 2011, 30 patients were enrolled in this study (median age 47 years). In the 28 evaluable patients, the overall response rate was 57.1 % (95 % CI 30-67 %), including 3 complete (10.7 %) and 13 partial (46.4 %) responses. Six (21.4 %) patients suffered from disease progression. With a median follow-up time of 13 months, the median time to disease progression was 8.6 months (95 % CI 6.2-10.6 months) and the median survival time was 27.2 months. Treatment-related adverse events were manageable, and no World Health Organization grade 4 toxicities were noted. Neutropenia observed in 6 (21.4 %) patients was the main grade 3 toxicity. Grade 3 nausea and vomiting were reported in 2 (7.1 %) and 3 (10.7 %) patients, respectively. Two (7.1 %) patients developed grade 3 hand and foot syndrome. CONCLUSION These results show that the combination of oral vinorelbine and capecitabine is an effective and well-tolerated first-line regimen for HER2/Neu-negative MBC patients pretreated with anthracyclines ± taxanes.
Collapse
Affiliation(s)
- Hesham Tawfik
- Clinical Oncology Department, Tanta University, Tanta, Egypt.
| | | | | |
Collapse
|
12
|
Aapro M, Finek J. Oral vinorelbine in metastatic breast cancer: A review of current clinical trial results. Cancer Treat Rev 2012; 38:120-6. [DOI: 10.1016/j.ctrv.2011.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/12/2011] [Accepted: 05/24/2011] [Indexed: 11/24/2022]
|
13
|
Kamal AH, Camacho F, Anderson R, Wei W, Balkrishnan R, Kimmick G. Similar survival with single-agent capecitabine or taxane in first-line therapy for metastatic breast cancer. Breast Cancer Res Treat 2012; 134:371-8. [PMID: 22460617 DOI: 10.1007/s10549-012-2037-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
Abstract
Capecitabine is often offered as a first-line chemotherapy option for metastatic breast cancer (MBC). In this study, we compare characteristics of and survival among women prescribed first-line capecitabine or taxane monotherapy for MBC. Women receiving first-line chemotherapy for MBC from 1998 to 2005 were identified from the North Carolina tumor registry linked with Medicaid and Medicare claims records, and were followed through the end of 2005 with survival data from the National Death Index. T Tests and Chi-square tests were used to compare baseline characteristics. Overall survival and cancer-specific survival were examined using Cox proportional hazard modeling. There were 257 patients with MBC starting first-line chemotherapy with capecitabine (n=71) or a taxane (n=186). No differences in age, race, or Charlson comorbidity status were observed between groups. Hormone receptor negative tumors (31.0 vs. 17.7%, p=0.02) and patients insured by Medicaid (28 vs. 12%, p=0.002) were more prevalent in the capecitabine group. Time from metastasis to first-line chemotherapy was longer in the capecitabine group (52 vs. 26% began after 3 months, p<0.001). In multivariate analysis, treatment received was not associated with overall or cancer-specific survival. Among standard demographics, age was the only factor significantly associated with overall survival (HR 1.02, p=04). In this population-based study, women who received capecitabine as first-line treatment for MBC were more often hormone receptor negative and insured by Medicaid. In multivariate analysis, first-line capecitabine and taxane for MBC yielded similar overall and cancer-specific survival outcomes.
Collapse
Affiliation(s)
- A H Kamal
- Multidisciplinary Breast Program, Division of Medical Oncology, Duke University Medical Center, Box 3841, 10 Bryan Searle Drive, 441 Seeley G. Mudd Building, Durham, NC 27710, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Leonard R, Hennessy BT, Blum JL, O'Shaughnessy J. Dose-Adjusting Capecitabine Minimizes Adverse Effects While Maintaining Efficacy: A Retrospective Review of Capecitabine for Metastatic Breast Cancer. Clin Breast Cancer 2011; 11:349-56. [DOI: 10.1016/j.clbc.2011.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/15/2011] [Accepted: 06/19/2011] [Indexed: 12/27/2022]
|
15
|
Wang Z, Lu J, Leaw S, Hong X, Wang J, Shao Z, Hu X. An all-oral combination of metronomic cyclophosphamide plus capecitabine in patients with anthracycline- and taxane-pretreated metastatic breast cancer: a phase II study. Cancer Chemother Pharmacol 2011; 69:515-22. [DOI: 10.1007/s00280-011-1728-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 08/16/2011] [Indexed: 11/21/2022]
|
16
|
Saridaki Z, Malamos N, Kourakos P, Polyzos A, Ardavanis A, Androulakis N, Kalbakis K, Vamvakas L, Georgoulias V, Mavroudis D. A phase I trial of oral metronomic vinorelbine plus capecitabine in patients with metastatic breast cancer. Cancer Chemother Pharmacol 2011; 69:35-42. [PMID: 21590447 DOI: 10.1007/s00280-011-1663-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 04/19/2011] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine the dose-limiting toxicities (DLTs) and the maximum tolerated doses (MTD) of oral metronomic vinorelbine with capecitabine in patients with metastatic breast cancer (MBC). PATIENTS AND METHODS Escalated doses of oral metronomic vinorelbine (starting dose 30 mg) every other day continuously and capecitabine (starting dose 800 mg/m(2) bid) on days 1-14 every 21 days were administered. DLTs were evaluated during the first cycle. RESULTS Thirty-six women were enrolled at eight escalating dose levels. For twenty-four patients, treatment was first line, for eight second line, and for four third line. The DLT level was reached at oral metronomic vinorelbine 70 mg and capecitabine 1,250 mg/m(2), and the recommended MTD doses are vinorelbine 60 mg and capecitabine 1,250 mg/m(2). DLTs were febrile neutropenia grade 3 and 4, diarrhea grade 4, and treatment delays due to unresolved neutropenia. There was no treatment-related death. The main toxicities were grade 2-3 neutropenia in 16.6% of patients each, grade 2-3 anemia 16.5%, grade 2-4 fatigue 27.5%, grade 2-3 nausea/vomiting 11%, and grade 3-4 diarrhea 8.2%. Two complete and 10 partial responses were documented. CONCLUSION Oral metronomic vinorelbine with capecitabine is a well-tolerated and feasible regimen that merits further evaluation in MBC.
Collapse
Affiliation(s)
- Zacharenia Saridaki
- Hellenic Oncology Research Group (HORG), 55 Lomvardou str, 11470 Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Mao W, Guan X, Tucker S, Li F, He Z, Wang J, Guo J, Wu S. Second-Line Combination Chemotherapy with Vinorelbine and Capecitabine in Patients with Advanced Breast Cancer Previously Treated with Anthracyclines and/or Taxanes. Chemotherapy 2011; 57:71-6. [DOI: 10.1159/000321489] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 07/31/2010] [Indexed: 11/19/2022]
|
18
|
Comen EA, Fornier MN. Algorithms for the treatment of patients with metastatic breast cancer and prior exposure to taxanes and anthracyclines. Clin Breast Cancer 2010; 10 Suppl 2:S7-19. [PMID: 20805067 DOI: 10.3816/cbc.2010.s.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
At present, metastatic breast cancer (MBC) remains an incurable disease, with the goals of care aimed at maximizing the patient's duration and quality of life. Treatment options for a patient with MBC have become more efficacious and numerous. In addition to endocrine and chemotherapy agents, a number of targeted agents, including trastuzumab and bevacizumab, are available. The option to use novel agents combined with a multitude of standard chemotherapies has further enhanced the landscape of therapeutic options. As such, specific regimens must be evaluated within the framework of the individual patient, answering such questions as whether to treat with sequential single agents or combination regimens as well as which agents to use and in what sequence. The concept of personalized care is even more apparent in the setting of MBC, where the goal of palliation is intrinsically more nuanced than that of curative intent. This review will broadly assess the evidence for current treatment options with attention to varying clinical scenarios. Ultimately, delivering quality of care necessitates balancing an understanding of evidence-based data with sensitive attention to quality-of-life goals.
Collapse
Affiliation(s)
- Elizabeth A Comen
- Department of Medicine, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
| | | |
Collapse
|
19
|
Hassan M, Osman MM. Combination of oral vinorelbine and capecitabine in the treatment of metastatic breast cancer patients previously exposed to anthracyclines: a pilot study. Hematol Oncol Stem Cell Ther 2010; 3:185-90. [DOI: 10.5144/1658-3876.2010.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
20
|
Petrelli F, Barni S. Oral vinorelbine: its role in advanced breast cancer pre-treated with anthracycline and taxane chemotherapies. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0038-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|