Results of a phase III prospective, randomised trial, comparing mitoxantrone and vinorelbine (MV) in combination with standard FAC/FEC in front-line therapy of metastatic breast cancer
M. Namer et al., Results of a phase III prospective, randomised trial, comparing mitoxantrone and vinorelbine (MV) in combination with standard FAC/FEC in front-line therapy of metastatic breast cancer, EUR J CANC, 37(9), 2001, pp. 1132-1140
This comparative phase III trial of mitoxantrone + vinorelbine (MV) versus
5-fluorouracil + cyclophosphamide + either doxorubicin or epirubicin (FAC/F
EC) in the treatment of metastatic breast cancer was conducted to determine
whether MV would produce equivalent efficacy, while resulting in an improv
ed tolerance in relation to alopecia and nausea/vomiting. This multicentre
study recruited and randomised 281 patients with metastatic breast cancer;
280 were evaluable for response survival and toxicity (138 received FAC/FEC
, 142 received MV). Patient characteristics were matched in each arm and st
ratification for prior exposure to adjuvant therapy was made prospectively.
The overall response rate (ORR) was equivalent in tile two arms (33.3% for
FAG, FEC versus 34.5% for MV), but MV was more effective in patients who h
ad received prior adjuvant therapy (13% (95% confidence interval (CI) 3-23)
for FAC/FEC versus 33% (95% CI 20 47) for MV P = 0.025) with a better prog
ression-free survival (PFS) (5 months (range 1-18 months) versus 8 months (
range 1-27 months); P = 0.0007 for FAC/FEC versus MV, respectively) while F
AC/ FEC was more: effective in previously untreated patients (ORR 43% (95%
CI 33 53) versus 35% (95% CI 25-45), P = 0.26; PFS 9 months (range 0-29 mon
ths) versus 6 months (range 0 - 26 months) P = 0.014). Toxicity was monitor
ed through the initial six cycles of therapy; febrile neutropenia and delay
ed haematological recovery was more frequent for MV (P = 0.001), while naus
ea/vomiting of grades 3-4 was greater for FAC/FEC (P = 0.031), as was alope
cia (P = 0.0001), cardiotoxicity was the same for the two regimens. MV repr
esents a chemotherapy combination with equivalent efficacy to standard FAC/
FEC and improved results for patients who have previously received adjuvant
chemotherapy. Toxicity must be balanced to allow for increased haematologi
cal suppression and risk of febrile neutropenia with MV compared with a hig
her risk of subjectively unpleasant side-effects such as nausea/vomiting an
d alopecia with FAC/FEC. (C) 2001 Elsevier Science Ltd. All rights reserved
.