Vinorelbine was developed under the direction of the French pharmacist Pierre Poiter, who, in 1989, obtained an initial license for the dug under the brand name Navelbine. Originally approved to treat bronchial cancer, the drug received French certification for the treatment of non-small cell lung carcinoma in 1991. In 1994, GlaxoSmithKline sponsored vinorelbine for approval by the United States Food and Drug Administration, and in 2003, the drug was offered in the United States in generic form.
Biological Mechanisms and Treatment Indications
Also known as vinorelbine tartrate, the drug is a semi-synthetic analogue of another cancer-fighting drug, vinblastine – a naturally occurring chemical compound obtained from the periwinkle plant (Vinca minor). Vinorelbine is included in the class of pharmaceuticals known as vinca alkaloids, and many of its characteristics mimic the chemistry and biological mechanisms of the cytotoxic drugs vincristine and vinblastine.
Cancer cells have a rapid rate of mitosis (cell division), and these fast dividing malignant cells rely, in part, on a cell’s structural cytoskeleton to maintain their accelerated pace of replication. These cytoskeletal cancer-supporting structures are known as microtubules, a cell’s production of which is interrupted and inhibited by intravenous administrations of vinorelbine. Vinorelbine is typically used on its own or in combination with cisplatin, another cytotoxic drug with specific indications for certain types of solid tumors.
In addition to vinorelbine’s use to combat non-small cell lung cancer, recent clinical trials in the U. S. have included the drug’s experimental use in palliative care for patients with incurable esophageal or breast cancer. The utilization of vinorelbine in a palliative care role is, according to clinical researchers, quite promising.
Unlike some cytotoxic drugs that offer physicians a choice of intravenous or oral delivery, vinorelbine can only be injected into a patient’s vein. Vinorelbine is characterized by a high level of toxicity that oftentimes leads to inflammation at the injection site, and the drug must never be introduced into spinal cord fluid because this could quickly lead to a patient’s death.
While vinorelbine is effective in combating non-small cell lung carcinoma, as well as showing some promise in early clinical trials related to the treatment of breast and cervical cancer, the drug is noted for its extreme toxicity. Nearly all patients who are given vinorelbine will experience unwanted side-effects that must be closely monitored by a physician who has received special training in the use of the drug. While the nature and severity of vinorelbine’s side-effects can depend on the dosages given, there is some evidence to suggest that those patient’s whose liver has been compromised are at greater risk for serious complications. Some physicians avoid the use of vinorelbine in liver damaged patients altogether.
Vinorelbine’s side-effects include a significant decrease in bone marrow function (white cell production), which causes a suppression of a patient’s immune system, and as a result, doctors must monitor their patients closely for the presence of opportunistic infections and diseases. It is recommended that patients who are receiving vinorelbine inform their doctor immediately when confronted by fever, chills, shortness of breath, and abdominal pain or constipation. Some of these symptoms could be an indication of vinorelbine’s toxic effects on the central nervous system, and a discontinuation of use may be indicated.
Vinorelbine’s other side-effects include alopecia (hair loss), hypertension and hypotension (high or low blood pressure), anemia, hearing impairment, nausea, vomiting, and dizziness. In one French study, researchers concluded that approximately one percent of patients treated with vinorelbine had an increased risk for cardiac problems, though, this is roughly on par with other, similar cytotoxic drugs. Due to a variety of undesirable interactions, vinorelbine is typically excluded from concurrent use with the anticancer drugs Paclitaxel and mitomycin-C. It is also known that use of vinorelbine can cause patients to develop a hypersensitivity to radiological treatments for cancer.