Single agent vinorelbine as first-line chemotherapy in elderly patients with advanced breast cancer

Breast cancer arises in about 48% of patients (pts) older than 65 years. Chemotherapy is administered to elderly pts with advanced breast cancer (ABC) resistant to hormonal treatment or with visceral metastases. Vinorelbine (VNR), a semisynthetic vinca alkaloid, is active and well-tolerated in ABC reporting, as a single agent, an objective response (OR) rate of 41%-60%. The ELVIS (Elderly Lung cancer Vinorelbine Italian Study) trial demonstrated the tolerability and efficacy of VNR in elderly pts with advanced non-small cell lung cancer (JNCI 91: 66-72, 1999).

From January 1999 to December 2000, we analysed, retrospectively, our data about single-agent VNR as a first-line chemotherapy in elderly pts (> or = 70 years) with ABC. Twenty-four pts were analysed. VNR was administered at the dose of 30 mg/m2, i.v., days 1 and 8, every 3 weeks for a maximum of 6 cycles.

The main toxicity was (% of pts): grade (G) 3-4 neutropenia 25%; G 2 thrombocytopenia 4.1%; G 2 asthenia 25%; G 2-3 constipation 16.6%; and G 1 neurotoxicity 25%. No cycles of chemotherapy were omitted or postponed. Granulocyte colony-stimulating factor was administered in 12.5% of a total of 112 cycles. Nine (37.5%) objective responses (2 complete and 7 partial responses) were observed. The median duration of response and survival were 7 and 11 months, respectively.

These results suggest that single agent VNR is active and well-tolerated in elderly pts with ABC. Further prospective trials are warranted.