Vinorelbine plus 24-hour infusion of high-dose 5-fluorouracil and leucovorin as effective palliative chemotherapy for breast cancer patients with acute disseminated intravascular coagulation.

BACKGROUND

Cancer-related acute disseminated intravascular coagulation (DIC) is uncommon, but it is a severe complication resulting in a very dismal prognosis. Choosing the appropriate chemotherapy agents to treat the underlying cancer and stop the acute DIC process effectively, while avoiding chemotherapy-induced myelosuppression which may contribute to bleeding-related mortality, is difficult. Acute DIC in breast cancer is a rare condition and is not well studied. Therefore, we designed this study to determine the clinical characteristics and effective treatment for breast cancer patients with acute DIC.

PATIENTS AND METHODS

From March 1996 to November 2008, patients with histologically proven breast cancer who presented with acute DIC at National Taiwan University Hospital were retrospectively analyzed.

RESULTS

Sixteen patients were included in the study. Thirteen patients with breast cancer-related acute DIC were treated with various kinds of chemotherapy, one with tamoxifen, and two with supportive care only. Four patients responded to treatment; three of the responders received vinorelbine with high-dose 5-fluorouracil and leucovorin (HDFL), the other received vinorelbine with cisplatin. The median survival of the responders and non-responders was 13 months and 0.5 month (p<0.001). There were no grade 3 or 4 hematologic or non-hematologic toxicities in the patients receiving vinorelbine-HDFL.

CONCLUSION

Vinorelbine plus HDFL is considered a safe and effective palliative treatment of choice for breast cancer patients with acute DIC. Further prospective study is warranted.