Vinorelbine and Carboplatin in the Treatment of Advanced Non-Small-Cell Lung Cancer
Greenville Cancer Center Greenville, South Carolina Randomized trials in patients with advanced non-small-cell lung cancer (NSCLC) have demonstrated that the combination of vinorelbine (Navelbine) and cisplatin (Platinol), compared with vinorelbine alone, increases survival but also increases toxicity. In an effort to enhance survival and reduce toxicity, a phase I/II trial of vinorelbine and carboplatin was conducted. On the basis of the phase I experience in 22 patients, the regimen chosen for evaluation in phase II consisted of vinorelbine 30 mg/m2/week, carboplatin at an area under the concentration vs time curve of 7 (according to the Calvert formula) on a monthly basis, and granulocyte colony-stimulating factor (G-CSF) titrated according to the absolute neutrophil count. As in phase I, neutropenia was the major toxicity observed among the 42 patients in the phase II study. However, the use of G-CSF either in a reactive setting (after the development of neutropenia) or preemptively (prior to the development of neutropenia) limited the episodes of febrile neutropenia. The overall 1-year survival rate was comparable to results obtained with vinorelbine and cisplatin in large-scale trials, with a favorable toxicity profile. These results confirm the clinical activity of vinorelbine plus carboplatin in advanced non-small-cell lung cancer.
