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

Abstract

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.

A review and metanalysis of metronomic oral single-agent cyclophosphamide for treating advanced ovarian carcinoma in the era of precision medicine

“…6,16 MOC has been used as a single agent or in combination with other agents for several solid tumors, including sarcoma and ovarian, lung, and prostate cancers, with interesting results in disease palliation, particularly in metastatic breast carcinoma, with only a slight increase of toxicity. [17][18][19][20] In real life, MOC has demonstrated promising antitumor and antiangiogenic activity that may achieve prolonged progression-free survival (PFS) and improved objective response rates (ORRs) in patients with recurrent epithelial ovarian cancer (EOC) with progressive disease (PD) after intravenous systemic chemotherapy. 21 The co-administration of antiangiogenic agents may enhance these effects.…”

“…6,16 MOC has been used as a single agent or in combination with other agents for several solid tumors, including sarcoma and ovarian, lung, and prostate cancers, with interesting results in disease palliation, particularly in metastatic breast carcinoma, with only a slight increase of toxicity. 17–20…”