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Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences. Cancers (Basel) 2022; 14:cancers14020434. [PMID: 35053596 PMCID: PMC8774086 DOI: 10.3390/cancers14020434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Cardiovascular disease and cancer are the leading causes of hospitalization and mortality in high-income countries. Studies of myocardial infarction show a disadvantage for the female sex in terms of survival and development of heart failure after myocardial infarction. The extent to which this also applies to the co-occurrence of coronary heart disease and cancer was investigated and analyzed here in large registry studies. Particular attention has been paid to the four most common cancers and hematologic diseases associated with coronary artery disease requiring treatment. Abstract Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.
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Mamoshina P, Rodriguez B, Bueno-Orovio A. Toward a broader view of mechanisms of drug cardiotoxicity. CELL REPORTS MEDICINE 2021; 2:100216. [PMID: 33763655 PMCID: PMC7974548 DOI: 10.1016/j.xcrm.2021.100216] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiotoxicity, defined as toxicity that affects the heart, is one of the most common adverse drug effects. Numerous drugs have been shown to have the potential to induce lethal arrhythmias by affecting cardiac electrophysiology, which is the focus of current preclinical testing. However, a substantial number of drugs can also affect cardiac function beyond electrophysiology. Within this broader sense of cardiotoxicity, this review discusses the key drug-protein interactions known to be involved in cardiotoxic drug response. We cover adverse effects of anticancer, central nervous system, genitourinary system, gastrointestinal, antihistaminic, anti-inflammatory, and anti-infective agents, illustrating that many share mechanisms of cardiotoxicity, including contractility, mitochondrial function, and cellular signaling.
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Affiliation(s)
| | - Blanca Rodriguez
- Department of Computer Science, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Alfonso Bueno-Orovio
- Department of Computer Science, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
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Xue J, Han C, Jackson A, Hu C, Yao H, Wang W, Hayman J, Chen W, Jin J, Kalemkerian GP, Matuzsak M, Jolly S, Kong FMS. Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer. Radiother Oncol 2018; 133:213-219. [PMID: 30416046 DOI: 10.1016/j.radonc.2018.10.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/14/2018] [Accepted: 10/23/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Higher cardiac dose was associated with worse overall survival in the RTOG0617 study. Pericardial effusion (PCE) is a common cardiac complication of thoracic radiation therapy (RT). We investigated whether doses of radiation to the heart and pericardium are associated with PCE and overall survival in patients treated with thoracic radiation for non-small cell lung cancer (NSCLC). MATERIALS AND METHODS A total of 94 patients with medically inoperable/unresectable NSCLC treated with definitive RT in prospective studies were reviewed for this secondary analysis. Heart and pericardium were contoured consistently according to the RTOG1106 Atlas, with the great vessels and thymus of the upper mediastinal structures included in the upper part of pericardium, only heart chambers included in the heart structure. Clinical factors and dose-volume parameters associated with PCE or survival were identified via Cox proportional hazards modeling. The risk of PCE and death were mapped using DVH atlases. RESULTS Median follow-up for surviving patients was 58 months. The overall rate of PCE was 40.4%. On multivariable analysis, dosimetric factors of heart and pericardium were significantly associated with the risk of PCE. Pericardial V30 and V55 were significantly correlated with overall survival, but presence of PCE and heart dosimetric factors were not. CONCLUSION PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.
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Affiliation(s)
- Jianxin Xue
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA; Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Chengbo Han
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Andrew Jackson
- Departments of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, USA
| | - Huan Yao
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Weili Wang
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA
| | - James Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Weijun Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hanzhou, China
| | - Jianyue Jin
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA
| | | | - Martha Matuzsak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Struti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA; Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA.
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Abstract
The paper describes the case of a 69-year-old man with non-small-cell lung cancer who, owing to a mistake, received intravenously 500 mg of vinorelbine. Within 3 days of intoxication, the bone marrow of the patient was damaged with subsequent pancytopenia that did not respond to treatment. On the fifth day after the poisoning, features of intestinal obstruction appeared. The patient died on the sixth day after the drug overdose. The case presented by us constitutes the first description of a fatal iatrogenic poisoning with this drug.
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Zerna C, Guenther M, Folprecht G, Puetz V. Acute ischaemic stroke and myocardial infarction after chemotherapy with vinorelbine for non-small cell lung cancer: a case report. J Chemother 2016; 29:49-53. [PMID: 25579322 DOI: 10.1179/1973947814y.0000000232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Vinorelbine is an important chemotherapeutic agent which is used in metastatic non-small cell lung cancer. Case reports have described the occurrence of acute cardiac ischaemic events as a side effect. It has not been established whether the suspected mechanisms for cardiac ischaemia might also cause other vascular events. We report about a 70-year-old male with metastatic non-small cell lung cancer who received vinorelbine as an outpatient. The patient presents with a cardiovascular risk profile. He was admitted to the hospital 3 days later with acute left-sided hemiplegia and hemianopia. Brain computed tomography (CT) demonstrated acute right hemispheric ischaemic stroke. Nine days after admission, the patient additionally suffered ST elevation myocardial infarction. A coronary angiogram demonstrated high grade stenosis of the right coronary artery treated with two bare-metal stents. Caution should be noted in patients who present with a cardiovascular risk profile as they might be vulnerable experiencing acute ischaemic events.
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Affiliation(s)
- Charlotte Zerna
- a Department of Neurology , University Hospital Carl Gustav Carus , Dresden , Germany
| | - Michael Guenther
- b Heart Centre, Department of Internal Medicine and Cardiology , University Hospital Carl Gustav Carus , Dresden , Germany
| | - Gunnar Folprecht
- c University Cancer Center, University Hospital Carl Gustav Carus , Dresden , Germany
| | - Volker Puetz
- a Department of Neurology , University Hospital Carl Gustav Carus , Dresden , Germany
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Piccirillo MC, Daniele G, Di Maio M, Bryce J, De Feo G, Del Giudice A, Perrone F, Morabito A. Vinorelbine for non-small cell lung cancer. Expert Opin Drug Saf 2010; 9:493-510. [DOI: 10.1517/14740331003774078] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Gennaro Daniele
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Massimo Di Maio
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Jane Bryce
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Gianfranco De Feo
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Antonia Del Giudice
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Francesco Perrone
- Clinical Trials Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy ;
| | - Alessandro Morabito
- Thoraco-Pulmonary Medical Oncology Unit, National Cancer Institute, Via M Semmola, 80131 Napoli, Italy
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Jones RL, Ewer MS. Cardiac and cardiovascular toxicity of nonanthracycline anticancer drugs. Expert Rev Anticancer Ther 2006; 6:1249-69. [PMID: 17020459 DOI: 10.1586/14737140.6.9.1249] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Anthracyclines are a well-known cause of cardiotoxicity, but a number of other drugs used to treat cancer can also result in cardiac and cardiovascular adverse effects. Cardiotoxicity can result in the alteration of cardiac rhythm, changes in blood pressure and ischemia, and can also alter the ability of the heart to contract and/or relax. The clinical spectrum of these toxicities can range from subclinical abnormalities to catastrophic life-threatening, and sometimes fatal, sequelae. These events may occur acutely or may only become apparent months or years following completion of oncological treatment. Ischemia and rhythm abnormalities are treated symptomatically in most cases. Knowledge of these toxicities can aid clinicians to choose the optimal and least toxic regimen suitable for an individual patient.
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Affiliation(s)
- Robin L Jones
- Royal Marsden Hospital, Department of Medicine, Fulham Road, London SW3 6JJ, UK.
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Affiliation(s)
- Tawee Tanvetyanon
- Division of Hematology/Oncology, and Lung Transplantation Program, Division of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
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Ejlertsen B, Højris I, Hansen S, Møholt K, Kristensen B, Mouridsen HT, Andersen J, Rose C, Kjaer M. Combined epirubicin and vinorelbine as first-line therapy in metastatic breast cancer: a pilot study performed by the Danish Breast Cancer Cooperative Group. Breast 2004; 12:42-50. [PMID: 14659354 DOI: 10.1016/s0960-9776(02)00180-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This pilot study investigated the tolerability and efficacy of increasing doses of epirubicin and vinorelbine as first-line chemotherapy for metastatic breast cancer. Acute toxicity was manageable at all dose levels for combinations of epirubicin 60-90 mg/m2 on day 1 and vinorelbine 15-25 mg/m2 on days 1 and 8 repeated every 3 weeks. Myelotoxicity was the most frequent toxic event, with a significant increase in grade 4 leukopenia from 0% at dose level 1 (60+15 mg/m2) to 26% at dose level 6 (90+25 mg/m2). Signs of acute or chronic cardiotoxicity grades 2-4 were seen in 15% of the patients and included arrhythmia and decreased function. No significant association was established between dose and nonhematological toxicity. Objective responses were observed in 49 of the 99 evaluable patients (49.5%, 95% CI 39.9-59.2), 18 being complete and 31 partial responses. Responses were observed at all six dose levels. In conclusion, acute toxicity was manageable at all dose levels for combinations of epirubicin 60-90 mg/m2 on day 1 and vinorelbine 15-25 mg/m2 on days 1 and 8. In the treatment of advanced breast cancer, improvement of the antitumor efficacy by the addition of vinorelbine to epirubicin remains to be demonstrated in a randomized phase III trial.
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Affiliation(s)
- B Ejlertsen
- Department of Oncology, The Finsen Center, Rigshospitalet Bldg. 5012, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
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Abstract
Cytostatic antibiotics of the anthracycline class are the best known of the chemotherapeutic agents that cause cardiotoxicity. Alkylating agents such as cyclophosphamide, ifosfamide, cisplatin, carmustine, busulfan, chlormethine and mitomycin have also been associated with cardiotoxicity. Other agents that may induce a cardiac event include paclitaxel, etoposide, teniposide, the vinca alkaloids, fluorouracil, cytarabine, amsacrine, cladribine, asparaginase, tretinoin and pentostatin. Cardiotoxicity is rare with some agents, but may occur in >20% of patients treated with doxorubicin, daunorubicin or fluorouracil. Cardiac events may include mild blood pressure changes, thrombosis, electrocardiographic changes, arrhythmias, myocarditis, pericarditis, myocardial infarction, cardiomyopathy, cardiac failure (left ventricular failure) and congestive heart failure. These may occur during or shortly after treatment, within days or weeks after treatment, or may not be apparent until months, and sometimes years, after completion of chemotherapy. A number of risk factors may predispose a patient to cardiotoxicity. These are: cumulative dose (anthracyclines, mitomycin); total dose administered during a day or a course (cyclophosphamide, ifosfamide, carmustine, fluorouracil, cytarabine); rate of administration (anthracyclines, fluorouracil); schedule of administration (anthracyclines); mediastinal radiation; age; female gender; concurrent administration of cardiotoxic agents; prior anthracycline chemotherapy; history of or pre-existing cardiovascular disorders; and electrolyte imbalances such as hypokalaemia and hypomagnesaemia. The potential for cardiotoxicity should be recognised before therapy is initiated. Patients should be screened for risk factors, and an attempt to modify them should be made. Monitoring for cardiac events and their treatment will usually depend on the signs and symptoms anticipated and exhibited. Patients may be asymptomatic, with the only manifestation being electrocardiographic changes. Continuous cardiac monitoring, baseline and regular electrocardiographic and echocardiographic studies, radionuclide angiography and measurement of serum electrolytes and cardiac enzymes may be considered in patients with risk factors or those with a history of cardiotoxicity. Treatment of most cardiac events induced by chemotherapy is symptomatic. Agents that can be used prophylactically are few, although dexrazoxane, a cardioprotective agent specific for anthracycline chemotherapy, has been approved by the US Food and Drug Administration. Cardiotoxicity can be prevented by screening and modifying risk factors, aggressively monitoring for signs and symptoms as chemotherapy is administered, and continuing follow-up after completion of a course or the entire treatment. Prompt measures such as discontinuation or modification of chemotherapy or use of appropriate drug therapy should be initiated on the basis of changes in monitoring parameters before the patient exhibits signs and symptoms of cardiotoxicity.
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Affiliation(s)
- V B Pai
- Ohio State University, Children's Hospital, Columbus 43210, USA
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11
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Abstract
A 67-year-old woman with metastatic breast cancer experienced sudden and profound pulmonary edema within 45 minutes after completion of intravenous administration of vinorelbine tartrate on two occasions. Both times the drug was discontinued and the patient was treated aggressively with oxygen, intravenous furosemide, and a vasodilator. The patient suffered no lasting medical complications due to the reaction. Until clear documentation and the mechanism for occurrence of this reaction are known, patients receiving vinorelbine should be monitored closely, particularly in the first few hours after intravenous administration.
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Affiliation(s)
- C E Cattan
- Miller Drug Pharmacy, Bangor, Maine, USA
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12
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Kouroukis C, Hings I. Respiratory failure following vinorelbine tartrate infusion in a patient with non-small cell lung cancer. Chest 1997; 112:846-8. [PMID: 9315826 DOI: 10.1378/chest.112.3.846] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Vinorelbine tartrate (Navelbine [Burroughs Wellcome; Research Triangle Park, NC; Pierre Fabre Medicament; Paris, France]) is used in the treatment of non-small cell lung cancer (NSCLC), breast cancer, and some gynecologic malignant neoplasms. The reported prevalence of adverse effects involving the respiratory system is less than 5% and involves mostly dyspnea with occasional interstitial infiltrates. A patient with a hypercoagulable state and diffuse pulmonary NSCLC developed acute respiratory failure soon after vinorelbine infusion. Physicians should be aware of possible increased pulmonary toxicity of vinorelbine in patients with diffuse pulmonary NSCLC.
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Affiliation(s)
- C Kouroukis
- Department of Medicine, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Tononi A, Panzini I, Oliverio G, Pasquini E, Gianni L, Nicolini M, Ravaioli A. Vinorelbine chemotherapy in non small cell lung cancer: experience in elderly patients. J Chemother 1997; 9:304-8. [PMID: 9269613 DOI: 10.1179/joc.1997.9.4.304] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study involved 25 elderly (> 65 years old) patients (pts) with unresectable non small cell lung cancer (NSCLC) who were not eligible for polychemotherapy. The diagnosis of NSCLC was histologically or cytologically documented, and all of them had measurable or evaluable disease. The median age of the patients was 71 (range 65-77); 9 had been pretreated. The pts received 25 mg/m2 of vinorelbine weekly or bi-weekly depending on the results of blood tests. The treatment continued until disease progression or tolerance. No complete response was achieved: 3 pts (12%) had a partial response (RP) (8-12-14 months), 13 (52%) stable disease (SD) with an improvement in symptoms, such as cough and/or pain, and 9 pts (36%) progressed. Compliance with the therapy was acceptable. The main toxicity was hematological: neutropenia was observed in 16 pts, with only 1 case of grade 4 neutropenia without sepsis; grade 1-2 anemia occurred in 8 patients. The other toxicities included grade 1-2 neurotoxicity in 8 pts, chemical phlebitis in 2 pts and grade 3 cardiotoxicity reversible with medical treatment in 1 patient. The median survival time was 10 months (lower quartile 5 months, upper quartile 23 months) (Kaplan and Meyer method). Vinorelbine can be considered a rational choice in elderly pts with advanced NSCLC who are not suitable for aggressive polychemotherapy, with the aim of improving their quality of life in terms of symptoms and outpatient treatment.
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Affiliation(s)
- A Tononi
- Division of Oncology, Ospedale Infermi, Rimini, Italy
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15
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Jones SF, Burris HA. Vinorelbine: a new antineoplastic drug for the treatment of non-small-cell lung cancer. Ann Pharmacother 1996; 30:501-6. [PMID: 8740332 DOI: 10.1177/106002809603000513] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To review the chemistry, pharmacology, pharmacokinetics, clinical activity, adverse effects, and dosage and administration guidelines for vinorelbine in the treatment of non-small-cell lung cancer (NSCLC). DATA SOURCES A MEDLINE search (1989-1995) using the terms vinorelbine and Navelbine was conducted. Additional unpublished data were provided by Glaxo Wellcome Drug Information. STUDY SELECTION AND DATA EXTRACTION The articles chosen for inclusion all appeared in peer-reviewed journals. Pertinent abstracts, as judged by the authors, were also included. DATA SYNTHESIS Vinorelbine is a new semisynthetic vinca alkaloid approved by the Food and Drug Administration for the first-line treatment of patients with advanced NSCLC. The drug demonstrated a broad spectrum of antitumor activity in preclinical studies and produced dose-limiting neutropenia in Phase I trials. In Phase II studies, an overall response rate of approximately 30% was reported with single-agent vinorelbine. Furthermore, in large, multicenter, randomized Phase III trials, treatment with vinorelbine alone and in combination with cisplatin resulted in improved survival compared with controls. The drug was well tolerated, with granulocytopenia being the most commonly reported adverse effect. However, the incidence of fever and hospitalization associated with this granulocytopenia was exceptionally low. The recommended dose is 30 mg/m2 weekly administered by intravenous injection or infusion. CONCLUSIONS As no specific chemotherapy regimen has previously been regarded as standard therapy for advanced NSCLC, vinorelbine is a promising new treatment for this patient population. It has been shown in several randomized, controlled trials to increase survival without compromising quality of life.
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Affiliation(s)
- S F Jones
- Brooke Army Medical Center, Fort Sam Houston, TX, USA
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