Phase I study of vinorelbine by 96-hour infusion in advanced metastatic breast cancer

Fever and breast cancer: A critical review of the literature and possible underlying mechanisms

Fever is a common feature in various pathological conditions that manifests a series of molecular events in the internal milieu. Much less attention has been paid to the clinical importance and the management of fever in breast cancer patients. However, several studies have reported an association between postoperative fever and poor treatment outcomes in breast cancer patients. The fever is a side effect of chemotherapy and a manifestation of cancer recurrence. The postmenopausal breast cancer patients experience another body temperature disturbance that is known as a hot flashes. Here, we reviewed the literature regarding postoperative fever and the possible underlying molecular and cellular mechanisms. Then the efficacy of non-steroidal anti-inflammatory drugs was discussed as a therapeutic option to control postoperative fever. Finally, we reviewed the chemotherapy-induced neutropenic fever and cancer vaccination-induced fever.

Palmar-plantar erythrodysesthesia

Objective. To provide a comprehensive review of the chemotherapy induced dermatological toxi-city, palmar-plantar erythrodysesthesia (PPE), including clinical presentation, drugs implication in causing the reaction, and approaches for management.

Data sources. A search of MEDLINE (1966-2002), IDIS (1985- 2002) and CANCERLIT (1993-2002) databases was conducted using the terms (and variations of the terms) palmar-plantar erythrodysesthesia, hand-foot syndrome, and acral erythema. Bibliographies from selected articles were also reviewed for appropriate references.

Data extraction. The retrieved literature was reviewed to include all articles pertaining to the incidence, clinical presentation, mechanism, pathology, diagnosis, treatment and prevention of PPE.

Data synthesis. PPE is a distinctive, localized cutaneous reaction to certain antineoplastic agents. A number of drugs have been implicated, including most commonly cytarabine, fluorouracil, doxorubicin, and capecitabine. There appears to be an association with administration schedules that lead to elevated peak plasma concentrations, such as in high-dose therapy, or after prolonged periods of constant exposure, as with continuous infusions, regular oral dosing, or liposomal formulations. The extent and severity of the reaction, time of onset, and duration are variable. Symptoms can occur to both hands and feet, and include dysesthesia, paresthesia, erythema, swelling, pain, blistering, ulceration, and desquamination. Cessation of the offending agent appears to be the most important step in the management of PPE. Dose modification may be necessary for subsequent cycles. As the course of PPE is self-limiting, treatment is commonly supportive and based on the type and severity of symptoms encountered. This can include analgesia, emollient or soothing creams, wound care, and cold compresses. Administration of corticosteroids has produced mixed results. Pyridoxine shows promise as both a treatment and preventative strategy, although confirmation in prospective clinical trials is needed. Advice should be provided to patients to ensure prompt recognition of toxicity and plans for prevention and amelioration of symptoms provided.

Vinorelbine as a 96-hour continuous infusion in heavily pretreated patients with metastatic breast cancer: a cooperative study by the GEICAM group

The efficacy of vinorelbine given as a continuous infusion was evaluated in 47 patients with breast cancer who had received previous treatment with first-line, second-line, and third-line chemotherapy including taxanes and/or anthracyclines. For inclusion into the study, patients were required to have histology-proven bi-dimensionally measurable disease. The treatment schedule was a bolus injection of vinorelbine 8 mg/m(2) administered over 5-10 minutes on day 1 followed by vinorelbine 8 mg/m(2) continuous infusion on days 1-4, every 21 days for 6 cycles. On an intent-to-treat basis, a 2% complete response rate and a 17% partial response rate were observed. The median time to progression was 2.4 months (95% CI, 1.83-2.97). Median survival was 7.73 months (95% CI, 4.48-10.98; range, 0.33-55.0 months). Major toxicities included febrile neutropenia in 40 cycles (24%) affecting 24 patients (51%) and 1 toxic death. Other nonhematologic toxicities included stomatitis (13%) and asthenia (13%). We conclude that this treatment shows considerable therapeutic activity, albeit at considerable toxicity costs, even in patients who have had multiple lines of prior chemotherapy. However, the results do not indicate clear advantages compared to the conventional weekly scheme of administration.

Hand-foot syndrome associated with short infusions of combination chemotherapy with gemcitabine and vinorelbine

The hand-foot syndrome (palmar-plantar erythrodysesthesia) is a side-effect which is associated with several cytotoxic agents (e.g. 5-fluorouracil, UFT, capecitabine, cytarabine, doxorubicin, liposomal-encapsulated doxorubicin). An association with a prolonged infusion of high doses of vinorelbine has also been described. To date a hand-foot syndrome after gemcitabine or short infusions of vinorelbine has not been reported before. The patient described here had a non-small-cell lung cancer stage IIIB disease and developed a hand-foot syndrome after short infusions of standard-dose chemotherapy of a combination with gemcitabine and vinorelbine.