Vinorelbine chemical structure
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Vinorelbine

Vinorelbine (Navelbine®) is a chemotherapy drug that is given as a treatment for some types of cancer, including breast cancer and non-small-cell lung cancer. more...

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Pharmacolgy

Vinorelbine is a vinca alkaloid. It is obtained by semi-synthesis from alkaloids extracted from the rosy periwinkle, Catharanthus roseus.

History

Vinorelbine was invented in the 1980s by scientists at the pharmaceutical arm of the Pierre Fabre Group. The drug was approved in France in 1989 under the brand name Navelbine for the treatment of bronchial cancer. It gained approval to treat non-small cell lung cancer in 1991 and this cancer is what the drug is now primarily used to treat. Vinorelbine received FDA approval in December 1994 sponsored by GlaxoSmithKline. The drug went generic in the US in February 2003.

Side-effects

Vinorelbine has a number of side-effects that can limit its use:

Lowered resistance to infection, bruising or bleeding, anaemia, constipation, diarrhoea, nausea, numbness or tingling in hands or feet (peripheral neuropathy), tiredness and a general feeling of weakness (asthenia), inflammation of the injected vein (phlebitis).

Less common effects are hair loss, allergic reaction.


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Fatal Pulmonary Toxicity Resulting From Treatment With Gemcitabine And Vinorelbine Association
From CHEST, 10/1/99 by Jean L Breton

Purpose: Case 1: A 69 years old man had an extensive NSCLC. Gemcitabine (800 mg/m2) and vinorelbine (25 mg/m2) were given weekly. 7 days after the ninth dose, he developed dry cough, tachypnea (30/mn), cyanosis and bilateral crackles with hypoxaemia (45 mmHg) and diffuse interstitial infiltrates on CT scan. Blood and BAL cultures, serology for mycoplasma, legionella and viruses were negative. Antibiotics (ceftazidime, amikacine trimethoprim) were started without clinical effect. Hypoxaemia became refractory to oxygen therapy with extension of interstitial infiltrates; the patient died 20 days after admission. Case 2: A 68 years old man had an metastatic NSCLC. Gemcitabine and vinorelbine were started according the same weekly scheme. After the tenth dose, the patient developed fever and crackles over the right lung field. Antibiotics were given and chemotherapy was interrupted. A week later, an ARDS occured with refractory hypoxaemia and diffuse interstitial infiltrates on CT scan. Mechanical ventilation and parenteral corticotherapy were immediately started: pulmonary infiltrates were resolved within a few days, but the patient died because pulmonary embolism. Gemcitabine is an analog of deoxycytine with significant activity against solid tumors. Transient dyspnoea has been reported in less 10 % of patients after the infusion, secondary to mild bronchospasm. Recently pulmonary toxicity with interstitial infiltrates and respiratory failure resulting from treatment with gemcitabine has been described in 6 published cases, with pathological findings consistant with diffuse alveolar damage, intra alveolar odema with interstitial inflammation. It was postulated that the pathogenesis is a capillary leak syndrome, such as that seen with another nucleotid analog, cytosine arabinoside, which is structurally similar. It is important to recognize this pulmonary toxicity because it seems that corticosteroid therapy at an early stage could be effective.

Jean L Breton, MD(*); F Alfreijat, MD and I Guy, MD. General Hospital, Belfort, France.

COPYRIGHT 1999 American College of Chest Physicians
COPYRIGHT 2000 Gale Group

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