BEIRUT, LebanonVinorelbine (Navelbine) plus capecitabine (Xeloda) is a
highly effective and well tolerated first-line chemotherapy regimen for
metastatic breast cancer, according to results of a recent 30-patient
multicenter phase II trial. Investigators reported a response rate of 67%, with
the main toxicity being grade 3/4 neutropenia in 13% of patients.
The combination represents a promising alternative regimen, with acceptable
toxicity and improved patient convenience, according to investigator Marwan
Ghosn, MD, associate professor and chairman of the department of
hematology-oncology at Saint-Joseph University School of Medicine, Beirut,
"The toxicity is very mild, and can be managed very easily," Dr. Ghosn said.
When oral vinorelbine becomes available he anticipated patients with metastatic
breast cancer being able to receive all their first-line chemotherapy orally at
home, rather than having to travel to a medical facility for IV treatment.
Dr. Ghosn reviewed previous research showing that the combination regimen of
vinorelbine and fluorouracil (5-FU) is effective in advanced breast cancer and
a subsequent phase I study, presented at San Antonio Breast Cancer Symposium in
2000, showing that capecitabine plus vinorelbine has promising antitumor
activity. "Capecitabine should be able to replace the less convenient
infusional 5-FU within combination chemotherapy regimens," Dr. Ghosn said.
Thirty Women Enrolled
Thirty women (median age 54 years) with metastatic breast cancer enrolled in
the study of vinorelbine/capecitabine as first-line treatment. Nearly 75% of
the patients had visceral metastasis, and nearly 75% had two or more metastatic
sites. Prior treatment included adjuvant/neoadjuvant chemotherapy in 67% and
hormone therapy in 57%. Prior treatment with capecitabine or vinorelbine was
The 3-week schedule included vinorelbine 25 mg/m2 IV on days 1
and 8, plus oral capecitabine 825 mg/m2 twice daily for 14 days.
Evaluation of antitumor activity occurred every 9 weeks, while safety was
evaluated every cycle. Patients received a total of 195 cycles, with a median
of six cycles per patient.