Future directions for vinorelbine (Navelbine)

Metastatic breast cancer is treated with sequential hormone therapy for hormone-sensitive subgroups of patients, and combination chemotherapy for hormone-refractory tumors. The judicious utilization of both hormonal therapy and chemotherapy results in palliation for the majority of patients with this disease. In recent years, several new, exciting cytotoxic agents have reached clinical development. Among these is vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Medicament, Paris, France), a new vinca alkaloid clearly of great interest. Vinorelbine administered as a single agent following the weekly intravenous route of administration resulted in major objective responses in 45% of patients. Even in patients previously exposed to standard chemotherapy, 20% to 30% achieved a major objective regression. Front-line chemotherapy with vinorelbine associated with an anthracycline or 5-fluorouracil resulted in remission rates and durations, as well as survival times, comparable to those achieved with standard combinations. Combinations containing vinorelbine are being introduced in the adjuvant and neoadjuvant settings. Furthermore, additional schedules of administration of vinorelbine are being explored, including dose intensification in single-agent and combination trials. Vinorelbine is an effective agent for the treatment of metastatic breast cancer, and represents a welcome addition to our treatment armamentarium.