This study is designed to evaluate the clinical effects of the addition of metronomic oral vinorelbine to letrozole and anastrozole. The study will compare the efficacy and tolerability of oral metronomic vinorelbine administered in combination with letrozole or anastrozole, as treatment for hormone receptor-positive advanced or metastatic breast cancer without resistance to Aromatase Inhibitors (AI).
Letrozole and Anastrozole are AI generally used as the first line of therapy for women with HR+ breast cancer. Furthermore, present hormonal treatments of advanced breast cancer (ABC) or Metastatic breast cancer (MBC) are sub-optimal, as only approximately one half of patients with oestrogen and/or progesterone receptor positive tumours will respond to therapy. For this patient population, chemotherapy is a valid option, especially after failure or intolerance to hormone therapy. Both combination and sequential single-agent chemotherapy are reasonable options. Based on the available data, sequential monotherapy is recommended as the preferred choice for MBC. Preferred first-line chemotherapy single agents are anthracyclines, taxanes, capecitabine, gemcitabine and vinorelbine. The development of oral chemotherapy formulations offer numerous benefits to patients, oncologists, oncology nurses, pharmacists and healthcare providers Metronomic therapy (MT) refers to repetitive, low doses of chemotherapy drugs. MT exerts an effect not only on tumor cells, but also on their microenvironment. In particular, the low-dose schedule compromises the repairing process of endothelial cells, leading to an anti-angiogenic effect. A systematic review of the results of phase I, II and III studies suggests that MT is a treatment option for breast cancer patients, has a low toxicity profile, efficacy in most patients and has potentially significant cost-effective advantages for public health.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
98
Letrozole 2.5 mg daily
anastrozole 1 mg daily
50 mg three times a week (Monday Wednesday and Friday)
CHU Besançon
Besançon, France
progression-free survival (PFS)
Progression Free Survival is defined as the time from randomization until objective tumor progression or death from any cause if progression did not occur. Subjects will also be considered to have progressed if they have treatment discontinuation with documented evidence of clinical deterioration due to breast cancer. If a patient has not an event, PFS will be censored at the date of the last adequate tumor assessment.
Time frame: up to 5 years
health-related quality of life using HRQoL QLQ-C30 and BR23
using EORTC QLQ-C30 (targeted dimensions: Global Health, physical and Emotional Dimensions, Fatigue and pain) HRQoL will be considered as the first secondary endpoint in order to confirm clinical benefit for the patient since we need more follow up to observe an impact on overall survival (OS).
Time frame: up to 5 years
overall response rate (ORR)
ORR and as defined by RECIST 1.1.
Time frame: up to 5 years
clinical benefit rate (CBR)
CBR, defined as percentage of patients with complete response (CR), partial response (PR) per RECIST or stable disease (SD) lasting 24 weeks or longer
Time frame: up to 5 years
Safety assessed by NCI CTCAE version 4.0",
using NCI CTCAE version 4.0
Time frame: up to 5 years
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