IS THERE A ROLE FOR VINDESINE IN THE TREATMENT OF NONSMALL CELL LUNG-CANCER

Vindesine is a semisynthetic derivative of vinblastine which has been evaluated in clinical studies since the late 1970's. The literature on vindesine in the treatment of non-small cell lung cancer has been rev iewed and all aspects of vindesine treatment in this disease has been covered. It is concluded that vindesine as a single agent yields a res ponse rate of 18% based on the treatment of 295 patients included in p hase II trials (95% confidence limits 13%-22%). No difference was obse rved among the three major histologic types of non-small cell lung can cer. In phase III trials, the response rate and confidence limits are at a similar level. Combination chemotherapy including vindesine plus cisplatin ranks among the most active treatments in non-small cell lun g cancer and is as active as etoposide plus cisplatin, both with respe ct to response rate and survival. It has not been documented that the addition of one or two other drugs to the combination of vindesine yie lds an increase in survival. When best supportive care was compared wi th a combination of vindesine plus cisplatin, the group with chemother apy was attributed a survival advantage in all three studies published , and the difference was statistically significant in two of these thr ee studies. Thus, vindesine has a well documented activity in non-smal l cell lung cancer and ranks among the most active single agents in th is disease. Vindesine is also part of several active combination chemo therapies among which the combination of vindesine plus cisplatin is p articularly interesting, because it has been repeatedly shown to prolo ng survival as compared to supportive care. Especially this latter poi nt leads to the conclusion that there is a role for vindesine in the t reatment of non-small cell lung cancer. However, the concept of chemot herapy in this disease remains investigational even though the advance s seen in recent years clearly merit further studies.