DI-036 Metronomic chemotherapy with oral vinorelbine: epidemiological analysis and economic evaluation

Background Vinorelbine is an antineoplastic drug belonging to the family of vinca alkaloids. Initially it was marketed for intravenous use and then it was made available as an oral formulation, to improve access and adherence to treatment, and to reduce procedures and costs of hospitalisation. Metronomic chemotherapy, compared with traditional schedules, is based on more frequent administration of low dose drugs, with the aim of preventing tumour angiogenesis. Purpose To investigate the use of metronomic chemotherapy with oral vinorelbine in our hospital; an epidemiological analysis and an economic evaluation were performed. Material and methods We examined prescriptions of vinorelbine and discharge sheets of oncology outpatient visits in 2015. We analysed the costs of the treatment schedules. Results 31 patients were treated with oral vinorelbine, 18 (58%) with the metronomic schedule (off-label) for metastatic breast cancer (15) and metastatic non-small cell lung cancer (3). Mean age was 69 years (range 43–85); almost all patients were women (30/31) and with a good performance status at the beginning of treatment (12 PS 0, 5 PS 1, 1 missing). 15 patients had progressive disease and 3 were partially responding. Mean length of this type of chemotherapy was 3 months, with good compliance and tolerance. In 2015, consumption of oral vinorelbine increased (+380% vs 2014), while consumption of the injectable formulation decreased (−44%). Direct costs of the oral formulation of vinorelbine (both metronomic and traditional schedule) were higher than the direct costs of the intravenous formulation; for the latter, we must however add the costs of hospitalisation and hospital staff for preparation and administration of the drug. Conclusion We can explain the rise in consumption of the oral formulation with the use of metronomic therapy and with an increase in the number of patients. The metronomic schedule was used as maintenance therapy and the preferred candidate is the elderly patient, a unique setting where the risk/benefit ratio of any antineoplastic treatment should be carefully evaluated. Metronomic chemotherapy with oral vinorelbine is an appealing option for patients who express their preference for oral chemotherapy. No conflict of interest