Vinorelbine

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Key Terms: Alkaloid, Microtubles, Palliative.

Definition

Vinorelbine is a drug used to treat certain types of lung cancer. Vinorelbine is available under the trade name Navelbine. The drug may also be referred to as vinorelbine tartrate, or didehydrodeoxynorvincaleukoblastine.

Purpose

Vinorelbine is an antineoplastic agent used to treat non-small cell lung carcinoma.

More recently, vinorelbine has been used in the palliative treatment of patients with advanced esophageal cancer and advanced breast cancer. Early reports of its effectiveness are encouraging.

Description

Vinorelbine was approved by the Food and Drug Administration (FDA) in 1994.

Vinorelbine is a semisynthetic derivative of vinblastine, a naturally occurring compound that is extracted from periwinkle plants. It belongs to a group of chemicals called vinca alkaloids. The chemical structure and biological action of vinorelbine is similar to vinblastine and vincristine.

Vinorelbine prevents the formation of microtubules in cells. One of the roles of microtubules is to aid in the replication of cells. By disrupting this function vinorelbine inhibits cell replication, including the replication the cancer cells.

Vinorelbine is used alone and in combination with cisplatin (another anticancer drug) to treat non-small cell lung carcinoma. It has been used in combination with other drugs to treat breast cancer. As of 2000 vinorelbine was under investigation for the treatment for cervical cancer.

Recommended Dosage

Vinorelbine is administered by intravenous injection (directly into a vein) once per week. The initial dose may be adjusted downward depending on patient tolerance to the toxic side effects of treatment. If toxic effects are severe, vinorelbine treatment may be delayed or discontinued.

Precautions

Vinorelbine must be administered only by individuals experienced in the use of this cancer chemotherapeutic agent. Vinorelbine must only be administered intravenously. Accidental administration of vinorelbine into the spinal cord fluid is a medical emergency that may result in death. Vinorelbine has a low therapeutic index, which means it is unlikely there will be therapeutic benefit without toxic side effects. Certain complications can only be managed by a physician experienced in the use of cancer chemotherapeutic agents.

Because vinorelbine is administered intravenously and is extremely irritating, the site of infusion and surrounding tissue should be monitored for signs of inflammation.

Blood tests are recommended to ensure that bone marrow function and the number of white blood cells is adequate for treatment to continue. Infections should also be controlled before vinorelbine treatment starts. Special caution should be used with patients whose bone marrow reserves have been reduced by previous radiation or chemotherapy treatment.

Vinorelbine may cause harm to a fetus when administered to pregnant women. Only in life-threatening situations should this treatment be used during pregnancy. Women of childbearing age are advised not to become pregnant during treatment. Women should stop nursing before beginning treatment due to the potential for serious adverse side effects in the nursing infants.

The safety of vinorelbine in children under 18 years of age has not been established.

Side Effects

The side effects of vinorelbine treatment are usually related to the dose of drug and are generally reversible. It is possible that toxic side effects may be more common in patients with poor liver function, and should be used with caution in those patients.

Decreased bone marrow function is the principal adverse side effect. This can reduce the number of white blood cells and increase the chance of infections. Patients should report fever or chills to their doctors immediately. Patients should also inform their doctor if they experience abdominal pain, constipation, or an increase in shortness of breath.

Toxicity of the nervous system is another side effect. Shortness of breath is a potentially severe side effect that patients should report to their doctor. Additional side effects, including fever, anemia, an increase or decrease in blood pressure, dizziness, nausea and vomiting, hearing impairment, and hair loss (alopecia) may occur.

Several cases of heart attacks related to vinorelbine have been reported. A group of French researchers estimates that about 1% of patients treated with vinorelbine will develop heart problems; however, vinorelbine does not appear to have a higher rate of these side effects than other drugs in its class.

Interactions

The use of vinorelbine in combination with another anticancer drug, mitomycin-C, has caused severe shortness of breath. Patients taking vinorelbine and cisplatin are more likely to experience a decrease in the number of white blood cells. This side effect should be carefully monitored to ensure that the number of white blood cells is adequate for treatment to continue. Patients taking vinorelbine and another anticancer drug, paclitaxel, may be more likely to experience toxicity of the nervous system, and should be carefully monitored for this. Drugs that may alter the metabolism of vinorelbine should be used with caution due to the potential for interactions.

Patients who are treated with vinorelbine during or following radiotherapy may become hypersensitive to radiation treatment.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Bronchogenic Carcinoma." Section 6, Chapter 81 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Karch, A. M. Lippincott's Nursing Drug Guide.Springhouse, PA: Lippincott Williams & Wilkins, 2003.

Periodicals

Garrone, O., E. Principe, M. Occelli, et al. "A Phase II Study of Epirubicin, Vinorelbine and Cisplatin in Advanced Breast Cancer." Anticancer Drugs 15 (January 2004): 23–27.

Lapeyre-Mestre, M., N. Gregoire, R. Bugat, and J. L. Montastruc. "Vinorelbine-Related Cardiac Events: A Meta-Analysis of Randomized Clinical Trials." Fundamental and Clinical Pharmacology 18 (February 2004): 97–105.

Razis, E., P. Kosmidis, G. Aravantinos, et al. "Second-Line Chemotherapy with 5-fluorouracil and Vinorelbine in Anthracycline and Taxane-Pretreated Patients with Metastatic Breast Cancer." Cancer Investigation 22 (January 2004): 10–15.

Richel, D. J., and W. L. Vervenne. "Systemic Treatment of Oesophageal Cancer." European Journal of Gastroenterology and Hepatology 16 (March 2004): 249–254.

Organizations

American Society of Health-System Pharmacists (ASHP). 7272 Wisconsin Avenue, Bethesda, MD 20814. (301) 657-3000. .

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFO-FDA. .

Brand names: Navelbine®

Chemical formula:

Español:
• Tartrato de vinorelbina, Solución para inyección

Vinorelbine Tartrate Solution for injection

What is this medicine?

VINORELBINE is a chemotherapy drug. It targets fast dividing cells, like cancer cells, and causes these cells to die. This medicine is used to treat cancer, like lung cancer.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• blood disorders
• infection (especially chickenpox and herpes)
• liver disease
• lung disease
• nervous system disease
• previous or current radiation therapy
• an unusual or allergic reaction to vinorelbine, other chemotherapy agents, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

This drug is given as an infusion into a vein. It is administered in a hospital or clinic by a specially trained health care professional. If you have pain, swelling, burning or any unusual feeling around the site of your injection, tell your health care professional right away.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
• itraconazole
• voriconazole

This medicine may also interact with the following medications:
• cyclosporine
• erythromycin
• fluconazole
• ketoconazole
• medicines for HIV like delavirdine, efavirenz, nevirapine
• medicines for seizures like ethotoin, fosphenotoin, phenytoin
• medicines to increase blood counts like filgrastim, pegfilgrastim, sargramostim
• other chemotherapy drugs like cisplatin, mitomycin, paclitaxel
• vaccines

Talk to your doctor or health care professional before taking any of these medicines:
• acetaminophen
• aspirin
• ibuprofen
• ketoprofen
• naproxen

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Your condition will be monitored carefully while you are receiving this medicine. You will need important blood work done while you are taking this medicine.

This drug may make you feel generally unwell. This is not uncommon, as chemotherapy can affect healthy cells as well as cancer cells. Report any side effects. Continue your course of treatment even though you feel ill unless your doctor tells you to stop.

In some cases, you may be given additional medicines to help with side effects. Follow all directions for their use.

Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself. This drug decreases your body's ability to fight infections. Try to avoid being around people who are sick.

This medicine may increase your risk to bruise or bleed. Call your doctor or health care professional if you notice any unusual bleeding.

Be careful brushing and flossing your teeth or using a toothpick because you may get an infection or bleed more easily. If you have any dental work done, tell your dentist you are receiving this medicine.

Avoid taking products that contain aspirin, acetaminophen, ibuprofen, naproxen, or ketoprofen unless instructed by your doctor. These medicines may hide a fever.

Do not become pregnant while taking this medicine. Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information. Do not breast-feed an infant while taking this medicine.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• low blood counts - This drug may decrease the number of white blood cells, red blood cells and platelets. You may be at increased risk for infections and bleeding.
• signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine
• signs of decreased platelets or bleeding - bruising, pinpoint red spots on the skin, black, tarry stools, nosebleeds
• signs of decreased red blood cells - unusually weak or tired, fainting spells, lightheadedness
• breathing problems
• chest pain
• constipation
• cough
• mouth sores
• nausea and vomiting
• pain, swelling, redness or irritation at the injection site
• pain, tingling, numbness in the hands or feet
• stomach pain
• trouble passing urine or change in the amount of urine

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
• diarrhea
• hair loss
• jaw pain
• loss of appetite

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

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