Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study
Authors: Cazzaniga M. E. , Vallini I. , Montagna E. , Amoroso D. , Berardi R. , Butera A. , Cagossi K. , Cavanna L. , Ciccarese M. , Cinieri S. , Cretella E. , De Conciliis E. , Febbraro A. , Ferraù F. , Ferzi A. , Baldelli A. , Fontana A. , Gambaro A. R. , Garrone O. , Gebbia V. , Generali D. , Gianni L. , Giovanardi F. , Grassadonia A. , Leonardi V. , Marchetti P. , Sarti S. , Musolino A. , Nicolini M. , Putzu C. , Riccardi F. , Santini D. , Saracchini S. , Sarobba M. G. , Schintu M. G. , Scognamiglio G. , Spadaro P. , Taverniti C. , Toniolo D. , Tralongo P. , Turletti A. , Valenza R. , Valerio M. R. , Vici P. , Di Mauro P. , Cogliati V. , Capici S. , Clivio L. , Torri V. ,   The VICTOR Study Group, Cazzaniga M. E. , Vallini I. , Montagna E. , Amoroso D. , Berardi R. , Butera A. , Cagossi K. , Cavanna L. , Ciccarese M. , Cinieri S. , Cretella E. , De Conciliis E. , Febbraro A. , Ferraù F. , Ferzi A. , Baldelli A. , Fontana A. , Gambaro A. R. , Garrone O. , Gebbia V. , Generali D. , Gianni L. , Giovanardi F. , Grassadonia A. , Leonardi V. , Marchetti P. , Sarti S. , Musolino A. , Nicolini M. , Putzu C. , Riccardi F. , Santini D. , Saracchini S. , Sarobba M. G. , Schintu M. G. , Scognamiglio G. , Spadaro P. , Taverniti C. , Toniolo D. , Tralongo P. , Turletti A. , Valenza R. , Valerio M. R. , Vici P. , Clivio L. , Torri V. 
Published: September 2021

Abstract
Purpose
Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting.

Methods
We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%).

Results
Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines.

Conclusion
This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.