Vinorelbine for non-small cell lung cancer.

IMPORTANCE OF THE FIELD: Vinorelbine is a 'third-generation' vinca alkaloid approved for the treatment of NSCLC. The introduction of 'third-generation' drugs (vinorelbine, gemcitabine, taxanes) in platinum combination improved survival of patients with advanced NSCLC, with substantially similar results among the different drugs. Treatment toxicities are considerable in this setting. AREAS COVERED IN THIS REVIEW: This narrative review reports a synthesis of evidence available from published clinical trials, systematic reviews and meta-analyses on the activity and safety of vinorelbine, used as single agent or in combination chemotherapy in patients with NSCLC, from 1990 to 2009. WHAT THE READER WILL GAIN: When vinorelbine was administered in a weekly schedule without interruptions, the most common toxicity was neutropenia that often precluded administration of the drug, therefore, reducing the dose intensity. A schedule providing administration of vinorelbine on days 1 and 8 every 3 weeks seemed to improve the tolerability of the drug. Tolerability of the drug did not result lower in the elderly subset. None of the other 'third-generation' drugs were clearly better tolerated than vinorelbine. Moreover, in the adjuvant setting, vinorelbine is the only third-generation drug that demonstrated, in combination with cisplatin, a consistent improvement in survival on a long-term basis. TAKE HOME MESSAGE: Vinorelbine is an active and generally manageable therapeutic option for the treatment of both early and advanced NSCLC.