Authors' objectives:

The objectives of the review were to evaluate the clinical effectiveness and cost-effectiveness of vinorelbine in the management of breast cancer.

Authors' recommendations: According to the evidence derived from RCTs, vinorelbine monotherapy as first-line, second-line or subsequent therapy for ABC, may be more effective in terms of progression-free survival and survival than melphalan. However, melphalan is not representatie of conventional treatment for MBC, which limits the generalisability of the findings to the clinical setting. Vinorelbine monotherapy was not found to be more effective than other chemotherapy regimens in terms of response rates. In addition, the poor quality of the data on which these findings were based should be borne in mind. Vinorelbine as combination therapy with doxorubicin, 5-fluorouracil or mitoxantrone did not appear to be more effective than alternative combinations of chemotherapy in the treatment of MBC. Vinorelbine plus mitoxantrone may be associated with less nausea/vomiting and alopecia than FAC/FEC, but may result in more febrile neutropenia. The evidence from RCTs show that there were no data to support the use of vinorelbine either as a single agent or in combination over standard first-line chemotherapy with anthracyclines or other non-taxane containing regimens. The efficacy and toxicity profiles were similar, with no suggestion of superiority over existing treatments. Vinorelbine may be one possible option when an alternative agent is required. The evidence from uncontrolled Phase II studies appeared to indicate that vinorelbine has antitumour activity and an acceptable toxicity profile, but may be associated with leukopenia, granulocytopenia, nausea/vomiting and constipation when used as monotherapy and neutropenia, alopecia and nausea/vomiting when used in combination. The data from the uncontrolled studies on their own were inadequate due to the clinical diversity, statistical heterogeneity and lack of precision. This was in addition to the fact that uncontrolled studies are of a lower level of evidence due to the biases and lack of rigour that are inherent in such studies. The economic studies included in the review tended to compare vinorelbine with taxane therapy. When comparing the cost-effectiveness of vinorelbine, paclitaxel and docetaxel one economic evaluation found vinorelbine to be the most cost-effective intervention, one found vinorelbine to be the least expensive but also the least effective, and another found docetaxel to be the most cost-effective.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1260

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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