SINGLE-AGENT VINORELBINE IN THE TREATMENT OF UNRESECTABLE LUNG METASTASES FROM COLORECTAL-CANCER

Vinorelbine (VNR; 5'-nor-anydro-vinblastine) is a new semisynthetic vi nca alkaloid which has demonstrated significant clinical activity agai nst non-small cell lung cancer, bronchial adenocarcinoma, breast cance r, and head/neck squamous cell carcinoma. Moreover, vinorelbine has be en widely employed in combination with cisplatinum with or without 5-f luorouracil for the treatment of lung cancer and head/neck carcinomas. Sixteen consecutive patients with lung metastases from colorectal ade nocarcinomas were treated with vinorelbine tartrate (Navelbine R) give n at the dose of 25 mg/m(2) i.v. bolus every week for eight consecutiv e times employing metoclopramide as an antiemetic tool. All patients h ad previous surgery, two had adjuvant chemo-immunotherapy with i.v. 5- fluorouracil and oral levamisole, 5 patients had adjuvant radiotherapy , and 1 patient had chemotherapy with levofolinic acid and 5-fluoroura cil for advanced disease. Sites of disease included lung in all cases, liver metastases in 3 patients and nodal tumoral deposits in 2 cases. All patients entered in the study had lung disease as predominant sit e of disease and showed multiple metastases. One patient was not evalu able for response, toxicity and survival because he was lost to follow -up before completion of therapy. No major objective response was seen . Four patients had stable disease which lasted a mean of 5.2 months, and the remaining 11 patients showed progressive disease. Mean surviva l was 6.7+ months (range 4.0-12.0+ months). The treatment was quite we ll tolerated by most patients, granulocytopenia being the most frequen t side-effect. Nausea/vomiting was very mild with grade 1 episodes in 5 patients (33%). Grade 1 leukopenia was seen in 5 patients (33%), gra de 2 leukopenia in 3 patients (20%), and grade 3 in 2 cases (13%). Gra de 1 thrombocytopenia was recorded in 3 cases (20%). No significant ne urotoxicity was observed, except mild constipation in 4 cases (26%). T he activity of VNR on a weekly schedule against lung metastases from l arge bowel adenocarcinoma is very low, however it should be noted that the treatment was well tolerated by most patients.