vinorelbine regimen range between 22% and 36% in the reviewed literature. The 33.3% of response rate observed in our study was comparable with the efficacy seen in previous trials that composed of nonelderly patients. This age independent benefit of chemotherapy is consistent with other studies. A retrospective analysis of elderly patients with MBC managed with Irinotecan palliative chemotherapy showed that disease control was comparable to those reported in younger patients. Blum et al. made a Receptor Tyrosine Kinase Signaling pooled analysis of patients with MBC treated with capecitabine and found no statistical association between age and response, clinical benefit, or OS. As for tolerability, gemcitabine plus vinorelbine showed manageable hematologic and nonhematologic toxicities.
The mild to moderate toxicity Tie 2 was important to elderly patients in that quality of life was an important consideration for MBC, which was destined to be incurable. There was one toxic death for massive gastrointestinal hemorrhage. The patient did not seek hospital care or follow doctor,s hematostatic instructions and, thus, died at home. For this reason, we must emphasize the importance of selecting patients who are fully aware of the adverse events of treatment and who will cooperate with doctor when potential complications are indicated. The study of prognosis revealed no predictive factor of disease control, while response to treatment was the only factor conditioning PFS in the univariate analysis. ECOG performance status was an independent prognostic factor of OS in the multivariate analysis, while visceral metastasis and the number of metastatic site were significant only in the univariate analysis.
These results were not in accordance with previous study, which concluded that estrogen c-Met Signaling Pathway receptor status was an independent predictor for both time to progression and OS. We cannot exclude that limited sample size, age, genetic heterogeneity, prior treatment, or chemotherapeutic sensitivity could account for this difference. Furthermore, unlike other studies, visceral metastasis no longer correlated clearly with OS, suggesting that this classical poor prognosis feature may not have a major impact in elderly MBC patients receiving gemcitabine plus vinorelbine. It should be mentioned that this regimen showed response in all lines of treatment with the highest in the first and second line setting and in all sites of metastasis, but particularly in lung and lymph nodes.
One advantage of this combination federal state is that both drugs were administered on days 1 and 8 of every 3 weeks cycle, so patients just need to visit hospital twice every three weeks, which does not modify much their daily activities during the treatment period. It seems that elderly patients should not be excluded from gemcitabine/vinorelbine regimen just because of age. They should be given the same opportunity to receive palliative chemotherapy, but at the same time, proper guidance should be guaranteed and dose modification should be made when necessary. Taken together, the response rate of gemcitabine/vinorelbine regimen was relatively high, the toxicity was generally acceptable, and median PFS and OS were relatively long, this regimen may be regarded as a valuable alternative to the treatment of elderly MBC patients after anthracycline.