Which benefit from adding gemcitabine to vinorelbine in elderly (>or=70 years) women with metastatic breast cancer? Early interruption of a phase II study.
BACKGROUND
Since vinorelbine and gemcitabine are both active in breast cancer with moderate toxicity, in 2002 we started a phase II trial with a combination regimen in elderly patients.


METHODS
To evaluate complete plus partial response rates and toxicity of first-line vinorelbine 25 mg/m2 plus gemcitabine 1000 mg/m2 on days 1 and 8, every 3 weeks, in women>or=70 years with advanced breast cancer and measurable lesions. All patients underwent multidimensional geriatric assessment before enrollment. A two-step design was applied, and the trial would be completed if an overall response rate>or=30% was obtained with a grade 3-grade 4 (G3-G4) toxicity rate<or=25% (excluding neutropenia) in the first step.


RESULTS
Twelve eligible patients had a median age of 74 years. At MGA, eight patients were fit, three vulnerable, one frail due to major depression; only two patients had G3 comorbidities according to Cumulative Illness Rating Scale-Geriatric. Seventy-five percent of patients had visceral disease. We obtained only one partial remission (11.1%) and six stabilizations of disease in nine assessable patients, with a time to progression of 3 months. Three patients (25%) experienced G3 neutropenia, and three patients (25%) developed G3 anemia (one patient) and G3 gastrointestinal toxicity (two patients).


CONCLUSIONS
The promising response rates obtained with this combination by other authors could not be confirmed in our small cohort of older women with breast cancer, therefore the trial was prematurely terminated. We do not recommend the co-administration of gemcitabine to vinorelbine in women>or=70 years outside the setting of controlled clinical trials.
Basso
U
U
Department of Medical Oncology, Istituto Oncologico Veneto-IOV. Electronic address: u.basso@tin.it.
Fratino
L
L
Department of Medical Oncology, Centro Riferimento Oncologico-CRO, Aviano.
Brunello
A
A
Department of Medical Oncology, Istituto Oncologico Veneto-IOV.
Lumachi
F
F
Department of Endocrine Surgery, University Hospital, Padova.
De Salvo
G L
GL
Department of Clinical Epidemiology and Biostatistics, Istituto Oncologico Veneto-IOV, Italy.
Lonardi
S
S
Department of Medical Oncology, Istituto Oncologico Veneto-IOV.
Ghiotto
C
C
Department of Medical Oncology, Istituto Oncologico Veneto-IOV.
Koussis
H
H
Department of Medical Oncology, Istituto Oncologico Veneto-IOV.
Pasetto
L M
LM
Department of Medical Oncology, Istituto Oncologico Veneto-IOV.
Monfardini
S
S
Department of Medical Oncology, Istituto Oncologico Veneto-IOV.
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D015897:Comorbidity; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D011788:Quality of Life; D015996:Survival Rate; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine; D000093542:Gemcitabine
D003841:Deoxycytidine; D014747:Vinblastine; D000077235:Vinorelbine; D000093542:Gemcitabine