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Vinorelbine Shows Potential in Squamous Cell Cervical Cancer

Vinorelbine has moderate activity and a generally favourable toxicity profile in patients with squamous cell carcinoma of the cervix who have failed previous chemotherapy, according to results from a phase 2 trial. However, pain and neuropathy were noted in about one-fourth of the patients, respectively.

Cisplatin-based chemotherapy in combination with radiation or surgery has significantly improved the outcome of patients with cervical cancer, and has encouraged further study of other drugs to be used alone or in combination with cisplatin.

Vinorelbine is a semisynthetic vinca alkaloid that has been approved in the United States for the treatment of non-small cell lung cancer in combination with cisplatin and has shown activity against a number of other solid tumours and lymphomas. Activity has also been suggested in metastatic and squamous cell carcinoma.

Franco M. Muggia, MD, at the New York University Medical Centre, United States, and colleagues evaluated the use of vinorelbine in patients with squamous cervical cancer who had failed standard local chemotherapy.

The study included 44 patients with histologically proven persistent or recurrent squamous cell cervical carcinoma with documented disease progression. Patients were given vinorelbine (30 mg/m²) on days 1 and 8 every 21 days for a median of 2 cycles (range 1-10).

"Such a schedule would likely be more suitable than a weekly schedule when given in combination with platinum compounds," note the authors.

Objective responses were seen in 13.7% of patients, including 1 complete response and 5 partial responses. Moreover, 22.7% had stable disease at end of treatment.

The one complete responder had extra-pelvic disease and had received 9 cycles of vinorelbine therapy. Furthermore, in the partial responders, response sites were pelvic in 3 patients and extra-pelvic in 2. These patients had received a median of 8 cycles (range 4-10).

Grade 3 and 4 neutropaenia was the most common toxicity, occurring in 41% of patients. Three-fourths of the patients experienced some leucopaenia, the median nadir being 1600. Six patients had grade 3 anaemia and 15 had grade 2 anaemia, though these cases were likely related to the disease and not treatment.

Drug-related neuropathy was reported in 27% of the patients, and was severe in 6.8%. Pain was also reported by 27.2%, ranging from grade 1 to 4.

The authors hope that"[the vinca alkaloids] together with platinum, and perhaps also with taxanes, may play a role in multimodality approaches to cervical cancer in the future."

Gynecol Oncol 2004 Feb;92:2:639-43. "Evaluation of vinorelbine in persistent or recurrent squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study"

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