title: Dose-ranging study of metronomic oral vinorelbine in patients with advanced refractory cancer.
abstract: OBJECTIVE
  To determine the safe dose range and pharmacokinetics of metronomic oral vinorelbine and obtain preliminary data on biomarkers and efficacy in patients with advanced cancer.
  
  
  METHODS
  Successive cohorts of patients received escalated doses of oral vinorelbine given thrice a week until disease progression, unacceptable toxicity (UT), or consent withdrawal. UT was any grade 4 toxicity, or grade 2 or 3 toxicity that would result to longer than 2-week break during the first 2 months of treatment. Blood samples were collected for pharmacokinetics and quantification of angiogenesis regulatory proteins.
  
  
  RESULTS
  Sixty-two patients (median age, 60 years) enrolled at six dose levels from 20 to 70 mg and received treatment for median 12.25 weeks (range, 2-216+). Unacceptable toxicity occurred in two of six patients treated at 60 mg (leucopenia grade 4 and epistaxis grade 2) and in one at 70 mg (leucopenia grade 2). The upper metronomic dose was 50 mg. Objective antitumor response documented in eight cases and 32% of patients experienced disease stability for minimum 6 months. Three responders (renal cancer, medullary thyroid carcinoma, and Kaposi sarcoma) received nonstop treatment for over 3 years without overt toxicity. Low pretreatment levels of circulating interleukin-8, vascular endothelial growth factor, and basic fibroblast growth factor were found predictors of efficacy. Steady-state concentrations of vinorelbine and its active metabolite ranged from 0.5 to 1.5 ng/mL.
  
  
  CONCLUSIONS
  Metronomic administration of oral vinorelbine is feasible at doses up to 50 mg thrice a week and can yield sustainable antitumor activity without overt toxicity, probably through antiangiogenic mechanism. Further clinical investigation is warranted.
authors.affiliation: University of Ioannina, Medical School, Medical Oncology Division, University Hospital of Ioannina, Ioannina, Epiros, Greece. ebriasou@otenet.gr
authors.forename: Evangelos
authors.initials: E
authors.lastname: Briasoulis
authors.forename: Periklis
authors.initials: P
authors.lastname: Pappas
authors.forename: Christian
authors.initials: C
authors.lastname: Puozzo
authors.forename: Christos
authors.initials: C
authors.lastname: Tolis
authors.forename: George
authors.initials: G
authors.lastname: Fountzilas
authors.forename: Urania
authors.initials: U
authors.lastname: Dafni
authors.forename: Marios
authors.initials: M
authors.lastname: Marselos
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pavlidis
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000077235:Vinorelbine
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D014747:Vinblastine; D000077235:Vinorelbine