title: Sequential therapy with capecitabine followed by vinorelbine/cisplatin in patients with anthracycline/taxane-refractory metastatic breast cancer.
abstract: BACKGROUND
  Currently, there is no standard treatment for patients with anthracycline and taxane-refractory metastatic breast cancer (MBC). Capecitabine or vinorelbine plus cisplatin is an effective palliative regimen for taxane-refractory MBC. In this study, we analyzed the efficacy and toxicity of sequential therapy with capecitabine followed by biweekly vinorelbine plus cisplatin in 37 patients with anthracycline and taxane-refractory MBC in Taipei Veterans General Hospital.
  
  
  METHODS
  Capecitabine (2,500 mg/m2 twice daily for 2 weeks, followed by 1 week of rest) was repeated every 3 weeks until the disease progressed. Patients then received biweekly vinorelbine (25 mg/m2) plus cisplatin (40 mg/m2) (arm A, n = 17) or best supportive care (BSC) (arm B, n = 20) in accordance with patient preference and clinical judgment. The clinical variables and response to capecitabine were well balanced in both arms.
  
  
  RESULTS
  The overall response rate to capecitabine was 32%, with a complete response rate of 5% and a partial response rate of 27%. Stable disease was achieved in an additional 46%. The disease control rate with capecitabine was 78%. Median progression-free survival and overall survival with capecitabine were 5.9 and 9.5 months, respectively. There was a trend toward better overall survival in arm A patients compared with arm B (BSC) patients, though statistical significance was not reached (10.4 vs. 7.4 months; p = 0.08); however, a significantly better overall survival rate was observed in the subgroup with capecitabine-controlled disease (10.8 vs. 6.9 months; p = 0.015). The safety profile of vinorelbine/cisplatin was acceptable: only 6% developed grade 4 neutropenia.
  
  
  CONCLUSIONS
  We suggest that sequential therapy is not necessarily effective compared with capecitabine alone, but is probably effective in patients initially controllable with capecitabine.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Peng-Chan
authors.initials: PC
authors.lastname: Lin
authors.forename: Wei-Shu
authors.initials: WS
authors.lastname: Wang
authors.forename: Muh-Hwa
authors.initials: MH
authors.lastname: Yang
authors.forename: Chueh-Chuan
authors.initials: CC
authors.lastname: Yen
authors.forename: Ta-Chung
authors.initials: TC
authors.lastname: Chao
authors.forename: Liang-Tsai
authors.initials: LT
authors.lastname: Hsiao
authors.forename: Po-Min
authors.initials: PM
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D000069287:Capecitabine; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011446:Prospective Studies; D043823:Taxoids / Q000008:administration & dosage; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
chemical_list: D018943:Anthracyclines; D001952:Bridged-Ring Compounds; D043823:Taxoids; D003841:Deoxycytidine; C080625:taxane; D014747:Vinblastine; D000069287:Capecitabine; D002945:Cisplatin; D000077235:Vinorelbine; D005472:Fluorouracil