OncoTargets and Therapy (Apr 2019)

Treating advanced breast cancer with metronomic chemotherapy: what is known, what is new and what is the future?

  • Cazzaniga ME,
  • Biganzoli L,
  • Cortesi L,
  • De Placido S,
  • Donadio M,
  • Fabi A,
  • Ferro A,
  • Generali D,
  • Lorusso V,
  • Milani A,
  • Montagna E,
  • Munzone E,
  • Orlando L,
  • Pizzuti L,
  • Simoncini E,
  • Zamagni C,
  • Pappagallo GL

Journal volume & issue
Vol. Volume 12
pp. 2989 – 2997

Abstract

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Marina Elena Cazzaniga,1 Laura Biganzoli,2 Laura Cortesi,3 Sabino De Placido,4 Michela Donadio,5 Alessandra Fabi,6 Antonella Ferro,7 Daniele Generali,8,9 Vito Lorusso,10 Andrea Milani,11 Emilia Montagna,12 Elisabetta Munzone,12 Laura Orlando,13 Laura Pizzuti,6 Edda Simoncini,14 Claudio Zamagni,15 Giovanni L Pappagallo16 On behalf of the “Metronomic Chemotherapy in Advanced Breast Cancer” Study Group 1Medical Oncology Unit & Phase 1 Research Unit, ASST Monza, Monza, Italy; 2Medical Oncology Division, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy; 3Haematology and Oncology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy; 4Clinical Medicine and Surgery Department, University of Naples Federico II, Naples, Italy; 5Medical Oncology Breast Unit, AOU Città della Salute e della Scienza, Turin, Italy; 6Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy; 7Medical Oncology Unit, Santa Chiara Hospital, Trento, Italy; 8Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy; 9UO Multidisciplinare di Patologia Mammaria e Ricerca Traslazionale, ASST di Cremona, Cremona, Italy; 10Operative Unit of Medical Oncology, Oncology Institute of Bari, Bari, Italy; 11Division of Investigative Clinical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy; 12Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy; 13Medical Oncology & Breast Unit, “Antonio Perrino” Hospital, Brindisi, Italy; 14Breast Unit, ASST Spedali Civili di Brescia, Brescia, Italy; 15SSD Medical Oncology Addarii, Policlinico Sant’Orsola Malpighi, Bologna, Italy; 16Medical Oncology Unit, Azienda ULSS 3 Serenissima, Mirano-Dolo, ItalyAbstract: The prognosis for patients with locally advanced or metastatic breast cancer (mBC) remains poor, with a median survival of 2–4 years. About 10% of newly diagnosed breast cancer patients present with metastatic disease, and 30%–50% of those diagnosed at earlier stages will subsequently progress to mBC. In terms of ongoing management for advanced/metastatic breast cancer after failure of hormonal therapy, there is a high medical need for new treatment options that prolong the interval to the start of intensive cytotoxic therapy, which is often associated with potentially serious side effects and reduced quality of life. Oral chemotherapeutic agents such as capecitabine and vinorelbine have demonstrated efficacy in patients with mBC, with prolonged disease control and good tolerability. Use of oral chemotherapy reduces the time and cost associated with treatment and is often more acceptable to patients than intravenous drug delivery. Metronomic administration of oral chemotherapy is therefore a promising treatment strategy for some patients with mBC and inhibits tumor progression via multiple mechanisms of action. Ongoing clinical trials are investigating metronomic chemotherapy regimens as a strategy to prolong disease control with favorable tolerability. This article provides an overview of metronomic chemotherapy treatment options in mBC, with perspectives on this therapy from a panel of experts. Keywords: advanced breast cancer, metronomic chemotherapy, vinorelbine, tolerability, quality of life

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