Oral maintenance metronomic vinorelbine versus best supportive care in advanced non-small-cell lung cancer after platinum-based chemotherapy: The MA.NI.LA. multicenter, randomized, controlled, phase II trial

Marco Platania, Felice Pasini, Luca Porcu, Mattia Boeri, Francesco Verderame, Yasmina Modena, Alessandro Del Conte, Federico Nichetti, Marina Chiara Garassino, Antonia Martinetti, Elisa Sottotetti, Luigi Cavanna, Emanuela Vattemi, Daniele Pozzessere, Alessandro Bertolini, Luciana Irtelli, Carla Verri, Gabriella Sozzi, Claudia Proto, Ugo PastorinoValter Torri, Anna Paola Fraccon, Francesca Spinnato, Diego Signorelli, Giuseppe Lo Russo, Alessandro Tuzi, Rosaria Gallucci, Saverio Cinieri, Manlio Mencoboni, Paola Antonelli, Luca Giacomelli, Filippo de Braud

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Oral vinorelbine administered at the maximum tolerated dose has already showed activity and a good safety profile in advanced non-small-cell lung cancer (NSCLC). The MA.NI.LA study was a phase II, multicenter, randomized, controlled trial that aimed to assess the effects of a 'switched maintenance’ regimen with oral metronomic vinorelbine (OMV) in patients with NSCLC who had not progressed after first-line platinum-based chemotherapy. Patients and methods: Patients were randomly assigned in a 1:1 ratio to either OMV (50 mg three-times weekly) as maintenance treatment or best supportive care (BSC). The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective disease control rate (DCR, CR + PR + SD), safety and quality of life. Results: In total, 61 and 59 patients were assigned to OMV and BSC, respectively. At a median follow-up of 23.9 (IQR 10.2–38.2) months, patients treated with OMV reported a significantly lower progression rate compared to patient in the BSC arm (89% [54/61] vs 96% [56/58]; HR 0.73; 90% CI 0.53-0.999, p = 0.049). Median PFS for patients treated with vinorelbine was 4.3 months (95% CI 2.8–5.6) vs 2.8 months (95% CI 1.9–4.5) for patients receiving BSC. This benefit was specifically evident in patients aged ≥70 years, in current smokers, and in those who reported disease stabilization as best response to induction chemotherapy. OS and response rate and quality of life were similar in the two arms. Drop-out rate for major toxicity with OMV was unexpectedly high (25%, 14/61) mainly due to grade 3–4 neutropenia (11%, 7/61). Conclusions In patients with unselected NSCLC achieving disease control after platinum-based chemotherapy switch maintenance therapy with OMV prolonged PFS compared to BSC; however, the optimal dose of OMV requires further investigation.

Original languageEnglish
Pages (from-to)17-23
Number of pages7
JournalLung Cancer
Volume132
DOIs
Publication statusPublished - Jun 2019

Keywords

  • Metronomic therapy
  • NSCLC
  • Vinorelbine

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

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