An evaluation of the pharmacokinetics and clinical use of vinorelbine for NSCLC treatment

Introduction: Non-small-cell lung cancer (NSCLC) is one of the most frequently diagnosed cancers, and one of the leading causes of cancer-related mortality. As most newly diagnosed patients present distant metastases, chemotherapy is the treatment of choice. Chemotherapy also plays a central role in postoperative and radical treatment in addition to radiotherapy. Areas covered: This paper reviews the role of vinorelbine, both alone and in combination with platinum-derivates, in the treatment of NSCLC. The authors review its efficacy at different stages of disease and under different conditions. Specifically, the authors evaluate its pharmacokinetic and toxicity profile and provide insight into its future as an NSCLC therapeutic. Expert opinion: In the first-line treatment of advanced NSCLC, the use of vinorelbine-based regimens may be less efficacious in controlling disease than other combinations. However, since their activity is not related to histology, vinorelbine still has potential as a first-line treatment for NSCLC patients in whom histology has failed to distinguish non-squamous from squamous histotypes. The use of an oral formulation may furthermore improve tolerability and patient compliance. Vinorelbine should be the drug of choice in the adjuvant setting as the vinorelbine/cisplatin doublet is the only regimen so far that has led to a survival gain in two Phase III trials. In patients aged > 70 years, vinorelbine (together with gemcitabine) should furthermore be the reference drug for first-and second-line therapy when single-agent chemotherapy is the treatment of choice. However, new efforts still need to be made to develop oral schedules for NSCLC.