Multicenter phase 2 trial of metronomic oral VEX chemotherapy versus weekly intravenous paclitaxel for ER-positive/HER2-negative metastatic breast cancer

After first-line endocrine therapy plus CDK4/6 inhibitor for ER-positive, HER2-negative metastatic breast cancer (mBC), patients eventually develop resistance and become candidates for chemotherapy. The multicenter phase 2 METEORA trial in Italy compare metronomic oral vinorelbine-cyclophosphamide-capecitabine (VEX) chemotherapy versus weekly intravenous paclitaxel for these patients. VEX versus paclitaxel was associated with significantly improved time to treatment failure (median 8.3 versus 5.7 months) and progression-free survival (median 11.1 versus 6.9 months). VEX was associated with more, but manageable, toxicity compared with paclitaxel. The authors conclude that metronomic VEX may be one of the chemotherapy options for patients with ER-positive, HER2-negative mBC (visual abstract).