NEWS | A Second-Line Option for Mesothelioma?

Although survival was not significantly extended, the chemotherapy drug vinorelbine might be a treatment option for mesothelioma patients whose cancer has returned after first-line chemotherapy with pemetrexed.

A new study on vinorelbine as a second-line treatment finds that the drug is �moderately active� in mesothelioma patients who were initially treated with pemetrexed-based chemotherapy. Pemetrexed (Alimta), along with a platinum-based drug like cisplatin, is the primary first-line drug therapy for mesothelioma. But vinorelbine is gaining attention as a possible option for mesothelioma, in part because it is available in a less expensive generic form.

In �Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma�, the Italian authors detail the results of their study on 59 patients with unresectable pleural mesothelioma.  These patients had all been initially treated with pemetrexed and had a median age of 69. Because their mesothelioma had continued to progress, these patients were selected to receive vinorelbine every three weeks for a maximum of six cycles. In 34 cases, vinorelbine was their second-line treatment. The remaining 25 patients had already had more than one other kind of treatment, so vinorelbine was a further-line therapy.

In a third of the test subjects (20), vinorelbine stabilized the growth of their mesothelioma tumors. An additional nine patients experienced a �partial response�, making the overall rate of disease control with vinorelbine 49.1%.  However, the drug did not dramatically extend patient survival (overall survival was just 6.2 months).  Nonetheless, the researchers said it has an �acceptable toxicity profile�, causing mainly fatigue and constipation. A small number of patients experienced significant neutropenia, or a steep reduction in a certain type of white blood cell, but most side effects were less serious.

Not surprisingly, the mesothelioma patients who had the best response to vinorelbine as a second- or further-line treatment were those whose overall health was good to begin with and those who had experienced six or more months of progression-free survival after their first-line chemotherapy.

Vinorelbine inhibits tumor growth by interrupted mitosis, the process of chromosomal separation that is critical for cell division. The drug is derived from a plant called the rosy periwinkle and is marketed by Abbott Healthcare under the brand name Navelbine. It addition to mesothelioma, vinorelbine has also been used to treat breast and non-small cell lung cancer.


Zucali, PA, et al, Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma�, November 20, 2013, Lung Cancer, Epub ahead of print.

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