How effective is metronomic chemotherapy with vinorelbine and capecitabine in patients with advanced HER2-negative breast cancer?

This study investigated whether metronomic chemotherapy with oral vinorelbine (Navelbine) and capecitabine (Xeloda) was effective in treating patients with advanced HER2-negative breast cancer (BC). This form of treatment was found to be safe and effective for this patients group.

Metronomic chemotherapy is a form of treatment in which the minimum dose of a chemotherapy drug is continuously administered. This reduces the negative side effects of treatment while maintaining the medical benefits. Vinorelbine (VNR) and capecitabine (CAPE) are chemotherapy drugs which are known to show better results when administered together than separately. Metronomic chemotherapy with VNR and CAPE has shown positive results in HER2-negative patients, however these results have yet to be confirmed by a larger, repeat study.

This study involved 80 patients with locally advanced, metastatic BC. The average age of participants was 65.3 years.  All patients were HER2-negative. 65% of patients had hormone-receptor positive (HR+) tumors (dependent on the hormones estrogen or progesterone for growth). Patients were treated with 40 mg of mVNR 3 times a week and 500 mg of mCAPE 3 times a day continuously until disease progression or serious negative side effects occurred. The average follow-up time was 6 months.

48.8% of the participants experienced a complete or partial response to treatment (no evidence of disease or reduced disease following treatment). 55.8% of HR-positive patients responded to treatment while only 35.7% of those with triple-negative BC (not dependent on hormones or HER2 for growth) showed a response. The average time to response was just over 2 months. The response rate was higher in patients who had not received prior treatment (35.5%) compared to patients undergoing second-line treatment (25.6%).

1.1% of patients experienced low levels of neutrophils (a type of white blood cell). 1% experienced hand-foot syndrome (redness and swelling of the hands and feet), and 1% experienced nausea or vomiting. 

The study concluded that the metronomic use of VNR and CAPE in patients with HER2-negative BC is safe and effective. The use of metronomic therapy allows for longer treatment duration and good outcomes while reducing the risk of negative side effects.

In this study both the researchers and patients were aware of which treatment was being administered, this means the results may be somewhat influenced by this awareness. A fully blind study in which the treatments are randomly assigned to patients may be needed to confirm the results.

Discuss with your doctor whether metronomic chemotherapy could be an option for you.