Older patients with advanced breast cancer are less likely to receive chemotherapy
than younger patients. Vinorelbine is an attractive alternative in this setting because
of its clinical activity and low frequency of side effects. This multicenter, phase
II trial was designed to assess the safety and efficacy of intravenous vinorelbine
as first-line therapy in women > or = 60 years old.
Fifty-six women (median age, 72 years; range 60-84 years), with measurable advanced
breast cancer and no prior chemotherapy for metastatic disease, were enrolled and
included in the analysis. Vinorelbine 30 mg/m2 was administered weekly for 13 weeks
and then every two weeks until development of progressive disease; doses were reduced
or delayed to manage toxicity.
The objective response rate was 38% (95% confidence interval (95% CI): 24%-51%); median
duration of response, nine months; median time to disease progression in all patients,
six months. The major dose-limiting toxicity was hematologic, which led to a median
dose intensity of 20.6 mg/m2/week. Grade 3-4 nonhematologic toxicity consisted of
asthenia (7%); nausea and generalized pain (5%); vomiting, chest pain, abdominal pain,
and elevated AST (4%); fever, diarrhea, constipation, and injection site reaction
(2%). Neurotoxicity and alopecia were grade 1-2 and relatively infrequent.
Vinorelbine offers a promising alternative for the management of advanced breast cancer
in elderly patients who are concerned about the subjective side effects of cytotoxic
chemotherapy. The dose-limiting toxicity is neutropenia, which is readily managed
with dose adjustment. Nonhematologic toxicity, including gastrointestinal side effects,
is minimal. Randomized studies are warranted to compare the activity of vinorelbine
with that of other regimens in elderly patients.