Salvage Therapy with Vinorelbine in Advanced Non-Small-Cell Lung Cancer: A Retrospective Review of the Fox Chase Cancer Center Experience and a Review of the Literature

BackgroundPublished phase III non–small-cell lung cancer (NSCLC) literature has demonstrated minimal activity for salvage vinorelbine (response rate [RR], 0.8% in 1 published study); however, our clinical experience has been discordant with such reports.Patients and MethodsAll patients with NSCLC who had received vinorelbine at Fox Chase Cancer Center from June 2002 to June 2005 were identified. Evaluable patients had biopsy-proven, measurable, recurrent or metastatic NSCLC, had full medical records and imaging available, and had received ≥ 1 cycle of single-agent vinorelbine after first-line therapy. The primary endpoint was RR; secondary endpoints included safety, overall survival (OS), and time to progression.ResultsOf 52 patients, 39 were evaluable. Median age was 63 years and 59% of patients were women. The Eastern Cooperative Oncology Group performance status was 0 in 12.8% of patients, 1 in 53.8%, 2 in 25.6%, and 3 in 7.7%. Nearly 80% of patients underwent 2 lines of previnorelbine therapy; 38.4% underwent 3 lines, and 7.7% underwent 4 lines. Approximately, 28.2% had received previous epidermal growth factor receptor tyrosine kinase inhibitor therapy; 23% had brain metastases; and 84.6% had significant comorbidities. The most common dosing schedules were 25–30 mg/m2 on days 1 and 8 every 3 weeks. The median number of vinorelbine cycles was 3. The partial RR was 7.7%; 25.6% had stable disease; 43.6% had disease progression, and 23.1% were not radiographically assessed for response (but were included in the OS analysis). Approximately, 20.5% required dose reductions, predominantly for hematologic toxicities; nonhematologic toxicities were generally mild, and there were no treatment-related deaths. Nearly 31% received subsequent therapy after vinorelbine. Median OS was 5 months (n = 39), median time to progression was 3 months (n = 30), 1-year OS was 25.6%, and 2-year OS was 7.7%.ConclusionSalvage vinorelbine is active and well tolerated in patients with NSCLC. The RR exceeds that reported in the literature.