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Table 1 Recent clinical studies conducted within the past 5 years on treatment with apatinib or vinorelbine in patients with TNBC pretreated with chemotherapy or radiotherapy

From: Combined use of apatinib mesylate and vinorelbine versus vinorelbine alone in recurrent or metastatic triple-negative breast cancer: study protocol for a randomized controlled clinical trial

Study

Design

Subjects

Assignment

Treatment

Outcome measures

Conclusion

Treatment with apatinib

Hu et al. [13]

Phase II cohort study

84 patients previously treated with anthracycline and/or taxane: 25 in phase IIa trial: 59 in phase IIb trial

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Phase IIa trial: apatinib, daily dose of 750 mg

Phase IIb trial: apatinib, daily dose of 500 mg

ORR and CBR were 10.7% and 25.0%, respectively. Median PFS and OS were 3.3 and 10.6 months, respectively

An apatinib dose of 500 mg rather than 750 mg is the recommended starting dose for heavily pretreated patients with mTNBC with a measurable rate of partial response and PFS

Li et al. [22]

Retrospective analysis

44 patients with advanced TNBC with failed first-line or second-line therapy

Apatinib + capecitabine or capecitabine alone

Apatinib (500  mg) was orally administered daily on days 1–28 of each 4-week cycle and/or capecitabine (12,500  mg/m2) was orally taken twice daily for 14 days followed by a 7-day rest period until disease progression

PFS, ORR (CR + PR), DCR (CR + PR + SD), and toxicity

For apatinib + capecitabine or capecitabine alone: PFS, 5.5, 3.5 months; ORR, 40.9%, 13.4%; DCR, 68.2%, 31.8%

Treatment with a combination of apatinib and capecitabine can achieve a better efficacy and similar rate of serious adverse events compared with capecitabine alone, as the third-line treatment for advanced TNBC

Hu et al. [26]

Case report

A female patient with stage IV TNBC. She had previously undergone whole-brain radiation therapy. Paclitaxel, platinum, UTD1, capecitabine, gemcitabine, vinorelbine, and single-agent apatinib were then administered as first-line to fifth-line therapies

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Treatment with apatinib + CPT-11 + S-1 as the sixth-line therapy

Alleviation of the brain edema was achieved, and this was maintained for 7 months

Apatinib in combination with CPT-11 + S-1 to treat refractory BMs in a patient with TNBC

Zhou et al. [27]

Case report

A female patient with triple-negative spindle cell carcinoma

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After treatment failure with bevacizumab combined with albumin-bound paclitaxel and cisplatin, the patient was treated with apatinib

Apatinib was more effective than bevacizumab for this patient

Apatinib is a safe and effective drug for treating advanced spindle cell breast carcinoma, especially in patients who have a prior experience of chemotherapy failure, or a poor physical condition

Treatment with vinorelbine

Rodler et al. [20]

Phase I cohort study

50 patients with advanced TNBC

–

A 3 + 3 dose escalation design evaluated veliparib and vinorelbine, followed by veliparib monotherapy

Median PFS in 50 patients was 5.5 months

Veliparib (300 mg, twice daily) combined with cisplatin and vinorelbine is well-tolerated with encouraging response rates

Zhang et al. [21]

Prospective cohort study

44 patients with metastatic TNBC pretreated with anthracyclines and/or taxanes

–

Biweekly combination of vinorelbine and oxaliplatin (NVBOX)

ORR 31.6%, median PFS 4.3 months, OS 12.6 months

A biweekly NVBOX regimen is effective and well-tolerated as a second-line or third-line treatment for patients with mTNBC

Wang et al. [23]

Retrospective analysis

48 female patients with TNBC

–

Patients were given vinorelbine plus cisplatin (NP group, n = 22) or gemcitabine plus cisplatin (GP group, n = 26)

The ORR, DCR, and median TTP were 45.5%, 77.3%, and 5 months, respectively, in the NP group, and 46.2%, 80.8%, and 5.2 months, respectively, in the GP group

A lower incidence of thrombocytopenia and rash, and a higher incidence of phlebitis was found in the NP group compared to the GP group

Both the NP and GP regimens are active and tolerated in cases of metastatic TNBC with anthracycline and/or taxane resistance. These regimens may be used as a salvage treatment for metastatic TNBC

Du et al. [24]

Retrospective analysis

48 patients with metastatic TNBC pretreated with anthracyclines and one taxane

–

22 patients were treated with vinorelbine plus platinum (NP), and 26 patients with vinorelbine plus capecitabine (NX)

Total: ORR, 20.8%; CBR, 43.8%; median PFS, 4.4 months; median OS, 15.5 months

ORR and PFS were better in the NP arm versus NX

Vinorelbine-based combination chemotherapy shows moderate efficacy in the treatment of metastatic TNBC, and has manageable toxicity. The NP regimen shows potential superiority over the NX regimen.

Li et al. [25]

Retrospective analysis

41 patients with advanced TNBC (pretreated with anthracyclines and/or taxanes, before or after surgery) in whom disease progressed after a certain period of time

–

Treatment with vinorelbine plus platinum (NP) regimen

ORR, 34.1%; CR, 7.3%; partial response, 26.8%; stable disease, 34.1%; median OS, 18.9 months; PFS, 6.7 months

The NP regimen showed clinical activity in patients with metastatic TNBC, and the toxicity was acceptable and manageable

  1. PFS median progression-free survival, ORR objective response rate, DCR disease control rate, BM brain metastasis, TNBC triple-negative breast cancer, CBR clinical benefit rate, OS overall survival, CR complete response, PR partial response, SD stable disease, TTP time to progression