PO84 VISUALIZING TREATMENT AND OUTCOMES IN METASTATIC BREAST CANCER

Abstract

Background: Treatment of MBC is becoming more complex as more drugs are approved for this indication. A high proportion of these drugs are intravenous, and sequential use can have a detrimental effect on venous access, causing distress to the patient as well as preventing treatment. In the UK vinorelbine is licensed for the treatment of MBC and NSCLC as a single agent or in combination. Vinorelbine is a vesicant and when given intravenously can cause venous irritation, which in some cases can lead to thrombophlebitis. Administration site reactions are very common, occurring in more than 10% of patients (grade 3/4: 3.7%). We compared the incidence of venous toxicity with IV vinorelbine in patients with MBC and those with NSCLC, who generally receive vinorelbine as their first chemotherapy. Method: Case notes of all patients receiving IV vinorelbine during a 3 year period (2008 to 2011) at UHNS were reviewed retrospectively for incidence of thrombophlebitis. Results: We identified 39 patients; 11 received vinorelbine IV as a single agent for MBC whilst 28 received it with platinum as adjuvant chemotherapy for NSCLC. Median age was 55 and 67 years for MBC and NSCLC patients respectively. Patients with MBC had previously received at least 2 lines of chemotherapy (maximum of 5 previous lines), including combination regimens and nearly all had been administered IV, whereas all patients with NSCLC were chemo-naive. Almost half of the patients with MBC had prior history of venous access problems. Four required central line insertions for vinorelbine treatment. A total of 57 cycles (mean 5.1) were delivered for MBC and 93 cycles (mean 3.3) were delivered for NSCLC. Moderate to severe thrombophlebitis was recorded in 8 of the 11 patients with MBC (80%), compared to only 1 (3%) with NSCLC. A further two patients with MBC experienced mild thrombophlebitis and problems also occurred in a further four patients despite them having a central line inserted. Other side effects occurred at similar rates in both groups, apart from haematological toxicity which was slightly more pronounced in patients with NSCLC and probably related to combination treatment. Conclusions: Venous complications were frequent with intravenous administration of vinorelbine. A significantly higher incidence of thrombophlebitis was seen in patients with MBC. This was probably due vein damage from multiple lines of previous chemotherapy. We recommend consideration of oral administration of vinorelbine to reduce the need for central line insertion and to improve the patient experience and compliance.