Weekly Vinorelbine versus Docetaxel for Metastatic Breast Cancer after Failing Anthracycline Treatment

Abstract

Background: Vinorelbine and docetaxel are active in anthracycline-pretreated, metastatic breast cancer. We compared their efficacy. Patients and Methods: Patients were randomized to receive weekly vinorelbine (VIN) or weekly docetaxel (DOC), 6 weekly doses per 8-week cycle, with optional crossover (X-DOC vs. X-VIN. The primary end point was time to progression (TTP) on initial treatment. Remission induction, survival, and quality of life were secondary end points. Results: Among 122 poor risk patients, a non-significant trend for better TTP was seen for DOC, both on initial and on crossover treatment. Responses were seen on either treatment, but progression was more common with VIN than with DOC, while more patients had a response with X-DOC than with X-VIN. Survival was identical in those receiving only the initial VIN vs. DOC and in the subgroups receiving crossover treatments. Grade 3–4 toxicity, especially hematological toxicity resulting in treatment delay, was more common with VIN. Non-graded toxicity contributed to abandoning DOC. Quality of life scores reflected worse results in patients crossing treatment arms, in either direction. Conclusions: DOC showed marginally better activity but did not improve TTP or other endpoints over VIN in this poor risk population.

A Randomized Feasibility Study of Docetaxel Versus Vinorelbine in Advanced Breast Cancer

“…The patients randomized in this study were relatively heavily pretreated with the majority having received 2-3 lines of prior treatment for their metastatic disease. The lower response rates with vinorelbine as compared to docetaxel in this study concur with results reported in other studies [16]. However, the numbers in both this study and the other unselected study [16] are small and need to be interpreted with caution.…”

“…The lower response rates with vinorelbine as compared to docetaxel in this study concur with results reported in other studies [16]. However, the numbers in both this study and the other unselected study [16] are small and need to be interpreted with caution. With regard to toxicity, in the present study, grade 3-4 hematological adverse events and infection were tenfold greater with docetaxel as compared with vinorelbine, consistent with results in HERNATA [17].…”

“…TTP duration for those patients who crossed over was similar, but overwhelmingly vinorelbine had fewer significant grade 3-4 toxicities than docetaxel. Only two previous randomized studies have compared the efficacy of single agent docetaxel and vinorelbine following prior anthracycline exposure, one in an unselected population [16], and the other, HERNATA, in HER2 positive disease with trastuzumab used in both arms [17]. The patients randomized in this study were relatively heavily pretreated with the majority having received 2-3 lines of prior treatment for their metastatic disease.…”

A process for assessing the feasibility of a network meta-analysis: a case study of everolimus in combination with hormonal therapy versus chemotherapy for advanced breast cancer

“…However, this network, based on step 1, only allowed for an indirect comparison of everolimus (plus hormonal therapy) to the chemotherapies CD and CMF. Since these chemotherapy combinations were not of interest, the network was extended to include an additional 14 RCTs comparing alternative chemotherapies of interest [41,42,45-47,49,50,54,57-60,63],[65,66]. …”

A Systematic Review of Vinorelbine for the Treatment of Breast Cancer

“…Among the studies, vinorelbine as a single agent was compared with taxane alone in four trials , with capecitabine alone in two trials , with 5‐FU/LV and FAMtx (mitoxantrone, 5‐fluorouracil and leucovorin.) in one trial , and with a vinorelbine‐combined regimen in another trial .…”