Chan Arlene, Verrill Mark
Mount Medical Centre, Medical Oncologist, Mount Medical Centre, Perth 6000, Western Australia.
Eur J Cancer. 2009 Sep;45(13):2253-65. doi: 10.1016/j.ejca.2009.04.031. Epub 2009 May 20.
As anthracyclines and taxanes are frequently used in the adjuvant and first-line metastatic settings, capecitabine and vinorelbine are frequently used as monotherapy and in combination for metastatic breast cancer (MBC). In the absence of comparative, phase III data, retrospective analyses and cross-trial comparisons provide the only indication of the relative efficacy of these options.
We reviewed studies evaluating the 2 agents alone or in combination in MBC.
We identified 6 capecitabine and 2 vinorelbine phase III trials, numerous phase II monotherapy studies and 35 phase I/II studies exploring capecitabine-vinorelbine combination therapy (1 with trastuzumab in HER2-positive MBC).
For monotherapy, the limited, retrospective comparative evidence supported by consistent prospective data suggests that capecitabine is more effective than vinorelbine. Comorbidities, organ function tolerability, tumour biology and patient characteristics should also inform treatment choice. If combination therapy is deemed clinically appropriate, intravenous vinorelbine with capecitabine may be considered, potentially improving efficacy compared with monotherapy, but at the cost of increased toxicity. Randomised evaluation versus capecitabine monotherapy is ongoing. In contrast, cross-trial comparison suggests that addition of oral vinorelbine to capecitabine adds haematological toxicity without apparently improving efficacy in pretreated MBC. Data from small, single-arm, phase II studies in the first-line setting are more encouraging. In summary, the strongest clinical data support capecitabine monotherapy in the majority of patients. In certain populations, a capecitabine-vinorelbine combination may be appropriate but requires further validation in randomised trials.
由于蒽环类药物和紫杉烷类药物常用于辅助治疗和一线转移性乳腺癌的治疗，卡培他滨和长春瑞滨常用于转移性乳腺癌（MBC）的单药治疗及联合治疗。在缺乏III期对比数据的情况下，回顾性分析和跨试验比较是这些治疗方案相对疗效的唯一指征。
我们回顾了评估这两种药物单独或联合用于MBC治疗的研究。
我们确定了6项卡培他滨和2项长春瑞滨的III期试验、大量II期单药治疗研究以及35项探索卡培他滨-长春瑞滨联合治疗的I/II期研究（其中1项研究涉及HER2阳性MBC患者使用曲妥珠单抗联合治疗）。
对于单药治疗，有限的回顾性对比证据及一致的前瞻性数据表明，卡培他滨比长春瑞滨更有效。合并症、器官功能耐受性、肿瘤生物学特性及患者特征也应作为治疗选择的参考依据。如果认为联合治疗在临床上是合适的，可以考虑静脉使用长春瑞滨联合卡培他滨，与单药治疗相比可能提高疗效，但代价是毒性增加。与卡培他滨单药治疗的随机评估正在进行中。相比之下，跨试验比较表明，在卡培他滨基础上加用口服长春瑞滨会增加血液学毒性，且在预处理的MBC患者中并未明显提高疗效。一线治疗中来自小型单臂II期研究的数据更令人鼓舞。总之，最有力的临床数据支持大多数患者采用卡培他滨单药治疗。在某些人群中，卡培他滨-长春瑞滨联合治疗可能是合适的，但需要在随机试验中进一步验证。
