VINORELBINE FOR BREAST CANCER

The clinical and cost-effectiveness of vinorelbine for breast cancer: a systematic review and economic evaluation

Background

Metastatic breast cancer (MBC) is considered to be incurable and treatment is usually focused on relieving symptoms and improving quality of life (QoL) with as little treatment-related toxicity as possible. Vinorelbine (Navelbine), an anti-cancer agent used in patients with advanced disease, including MBC, relapsing after anthracycline treatment, may be a useful addition to the drugs available for the treatment of MBC. It can be used in a range of combination chemotherapy regimens in first- or second-line treatment, and may be used as monotherapy for vulnerable groups, such as the elderly. The objectives of this review were to evaluate the clinical effectiveness and cost-effectiveness of vinorelbine in the management of breast cancer.

Findings

The evidence from RCTs show that there were no data to support the use of vinorelbine either as a single agent or in combination over standard first-line chemotherapy with anthracyclines or other non-taxane containing regimens. The efficacy and toxicity profiles were similar, with no suggestion of superiority over existing treatments. Vinorelbine may be one possible option when an alternative agent is required.

The economic studies included in the review tended to compare vinorelbine with taxane therapy. When comparing the cost-effectiveness of vinorelbine, paclitaxel and docetaxel one economic evaluation found vinorelbine to be the most cost-effective intervention, one found vinorelbine to be the least expensive but also the least effective, and another found docetaxel to be the most cost-effective.

Conducted by: R Lewis1, A-M Bagnall1, S King1, N Woolacott1, C Forbes1, L Shirran1, S Duffy1, J Kleijnen1, G ter Riet2, R Riemsma1

1. NHS Centre for Reviews and Dissemination; 2. Department of General Practice, Academic Medical Centre, Amsterdam

Further details

Project page on HTA Programme website

Related guidance

Commissioned to inform NICE Technology Appraisal 54: Guidance on the use of vinorelbine for the treatment of advanced breast cancer. London: National Institute for Clinical Excellence; 2002. NB: This guidance has been updated and replaced by CG81 Advanced breast cancer.

Publications

Lewis R, Bagnall AM, King S, Woolacott N, Forbes C, Shirran L, Duffy S, Kleijnen J, ter Riet G, Riemsma R. The clinical effectiveness and cost-effectiveness of vinorelbine for breast cancer: a systematic review and economic evaluation. Health Technol Assess. 2002;6(14):1-269

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process