Efficacy of Metronomic Vinorelbine in Elderly Patients with Advanced Non-Small-Cell Lung Cancer and Poor Performance Status

Bilir, Cemil; Durak, Serdar; Kızılkaya, Bayram; Hacıbekiroğlu, İlhan; Nayır, Erdinç; Engın, Hüseyin

doi:10.3747/co.24.3486

Cited by 19 publications

(14 citation statements)

References 21 publications

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“…Lung cancer is the leading cause of cancer‐related deaths both in China and worldwide . Almost 80% of these patients have distant metastases when they are diagnosed, so they are not candidates for curative surgery . Epidermal growth factor receptor (EGFR) can be detected in 10% to 15% of white patients and in 40% to 50% of Asian patients .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Almost 80% of these patients have distant metastases when they are diagnosed, so they are not candidates for curative surgery. 3 Epidermal growth factor receptor (EGFR) can be detected in 10% to 15% of white patients and in 40% to 50% of Asian patients. 4,5 Several prospective and phase 3 clinical trials have reported that patients with a sensitive EGFR mutation have an objective response rate (ORR) of 70% to 80% with a median progression-free survival (PFS) of approximately 10 months.…”

Section: Introductionmentioning

confidence: 99%

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Complex epidermal growth factor receptor mutations and their responses to tyrosine kinase inhibitors in previously untreated advanced lung adenocarcinomas

Zhang

Wang

Qian

et al. 2018

Cancer

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These results from the largest sample size suggest that EGFR-TKI therapy is effective in patients with Del-19+21L858R mutations, Del-19/21L858R+atypical mutations, and double atypical mutations but is less effective in patients with a primary drug-resistant pattern. Patients with the Del-19+21L858R mutations may, therefore, benefit more from treatment with first-generation TKIs. Cancer 2018;124:2399-406. © 2018 American Cancer Society.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complex epidermal growth factor receptor mutations and their responses to tyrosine kinase inhibitors in previously untreated advanced lung adenocarcinomas

Zhang

Wang

Qian

et al. 2018

Cancer

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“…Of other toxicities reported, including diarrhea, nausea and vomiting, these are seldom severe and usually respond to treatment ( Depierre et al, 2001 ; Gregory and Smith, 2000 ). Additionally, metronomic vinorelbine (dense, nonbreak, low dose administration) is safely used and well tolerated, with some instances of treatment continuing for over 3 years without overt toxicity ( Briasoulis et al, 2009 ; Camerini et al, 2015 ; Bilir et al, 2017 ). Furthermore, one report of 62 patients treated with metronomic vinorelbine (20–70 mg thrice weekly) reported non-hematological toxicities to be practically absent, describing vomiting and nausea as negligible ( Briasoulis et al, 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Vinorelbine Potently Induces Placental Cell Death, Does Not Harm Fertility and is a Potential Treatment for Ectopic Pregnancy

et al. 2018

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Ectopic pregnancies complicate 1–2 pregnancies and are a leading cause of maternal death. An effective oral drug therapy that replaces surgery might make its treatment safer, cheaper, simpler and therefore more widely accessible. The only current medical treatment offered to women is intramuscular methotrexate, but this only reliably resolves smaller ectopic pregnancies. As such, many ectopic pregnancies require surgical excision. We show that vinorelbine, an orally available chemotherapeutic agent, potently induced placental cell death but did not harm fertility in mice. Vinorelbine was 100–1000 times more potent than methotrexate in inducing placental cell death in vitro, and more potent than combination methotrexate and gefitinib (another proposed treatment for ectopic pregnancy being evaluated in phase III trials). Mechanistically, it caused microtubule condensation, blocked mitosis and activated the apoptosis cascade in placental cells. Vinorelbine was more efficacious than methotrexate ± gefitinib in reducing the volume of placental cell tumors xenografted subcutaneously in SCID mice. Mice exposed to vinorelbine and allowed to breed, following a four week washout period, displayed normal fertility, however long-term fertility was not assessed. Human Fallopian tubes treated with vinorelbine did not exhibit up-regulation of apoptosis molecules. Our findings show that placental cells appear sensitive to vinorelbine and it has potential as a tablet-only approach to treat ectopic pregnancy.

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“…The metronomic approach is considered intriguing due to its anti-angiogenic effect and the possible synergy with molecularly-targeted agents and immune checkpoints inhibitors [ 12 – 14 ]. Moreover, lack of major side-effects while preserving anti-neoplastic activity makes this schedule highly attractive for the management of heavily pretreated patients or elderly/frail ones [ 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Metronomic oral vinorelbine in patients with advanced non-small cell lung cancer progressing after nivolumab immunotherapy: a retrospective analysis

Gebbia

Aiello

Banna

et al. 2020

ecancer

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Purpose: The availability of immune checkpoint inhibitors has deeply changed the therapeutic scenario of patients with advanced non-small cell lung cancer (NSCLC). Up until now, chemotherapy still represents the first-line treatment for patients with advanced NSCLC not harbouring genetic mutations or lacking high expression of programmed death ligand even if the addition of immunotherapy to first-line chemotherapy has recently been shown to improve clinical outcome. We carried out a multi-institutional retrospective analysis on third-line chemotherapy with metronomic oral vinorelbine (VNR) in a series of patients with metastatic NSCLC pre-treated with first-line chemotherapy and second-line immunotherapy. Patients and methods: Thirty patients with metastatic NSCLC with progressive disease after first-line chemotherapy and subsequent immunotherapy were treated with metronomic oral VNR continuously at the fixed dose of 30 mg three times per week. Results: A partial response was achieved in 4 patients (13.3%), while 10 patients (33.3%) displayed disease stabilisation for an overall disease control rate of 46.7%. Median progression-free survival was 3.9 months (range 1–13 months) and median OS reached 8.1 months (range 4.0–24.0+ months) with a 12-month survival rate of 22%. Conclusion: Oral metronomic VNR appears to be active and safe in patients with metastatic NSCLC in progression after first-line chemotherapy and second-line immunotherapy. The results reported, although from a limited sample, may suggest its use for long-term stabilisation of the disease with good patient compliance.

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Efficacy of Metronomic Vinorelbine in Elderly Patients with Advanced Non-Small-Cell Lung Cancer and Poor Performance Status

Abstract: Background Metronomic chemotherapy-administration of low-dose chemotherapy-allows for a prolonged

Cited by 19 publications

References 21 publications

Complex epidermal growth factor receptor mutations and their responses to tyrosine kinase inhibitors in previously untreated advanced lung adenocarcinomas

Complex epidermal growth factor receptor mutations and their responses to tyrosine kinase inhibitors in previously untreated advanced lung adenocarcinomas

Vinorelbine Potently Induces Placental Cell Death, Does Not Harm Fertility and is a Potential Treatment for Ectopic Pregnancy

Metronomic oral vinorelbine in patients with advanced non-small cell lung cancer progressing after nivolumab immunotherapy: a retrospective analysis

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