Vinorelbine in cancer
Clinical studies of a new drug from the Vinorelbine alkaloid series have shown that in patients with breast cancer the frequency of positive clinical dynamics is 35-60%. The average duration of remission was 6-9 months, and the life expectancy was 12-16 months. In many recommendations, "Vinorelbine" and combinations with his participation, are the main ones in the recurrence of cancer after the therapy.
In small-cell lung cancer, the drug is advised to be taken at all stages of the process. Even in the terminal phase of the process, the combination of Vinorelbine and Cisplatin showed an overall effect in 43% of patients, and stabilization of the process in 23% of cases.
What kind of cancer does Vinorelbine show?
The drug is prescribed for two types of oncological pathology:
- Small cell lung cancer.
- Metastatic breast cancer.
Composition and active ingredient
The drug is available in the form of a bottle for 1 or 5 ml of solution. In 1 ml of the drug contains 1, 3 mg vinorelbine tartrate, which corresponds to 10 mg vinorelbine. It refers to the cytostatic vinca alkaloids.
There is also an oral form of the drug. Release the drug in capsules of 20 or 30 mg of the active ingredient.
Dosage and how to properly take Vinorelbine
The weekly dosage of Vinorelbine is 25-30 mg per m2 of body surface area. The duration of therapy is usually 3-6 weeks.
Before the injection of the injection form of the drug, it is prepared by dilution in 50 or 125 ml of saline. Then it is slowly injected intravenously (10 to 30 minutes). At the end, an additional infusion of physiological solution is carried out to remove the drug residues.
Mechanism of action
"Vinorelbine" is able to influence the molecular level on the structure of microtubules. It inhibits the polymerization of tubulin. In large doses, the drug predominantly acts on axonal microtubules, and in usual - on mitotic. This leads to inhibition of mitosis in the G2 and M phases. As a result, the cells die during the next phase of the interphase. Since it is in tumor tissues that they most actively divide, Vinorelbine has the greatest influence on them.
Contraindications and important limitations in the use
Vinorelbine is contraindicated in the following situations:
- the presence of hypersensitivity reactions when using the drug in the past;
- period of pregnancy and lactation, as this drug has a teratogenic effect;
- acute liver failure, which is due to the fact that "Vinorelbine" is metabolized in the liver;
- it is not advisable to prescribe a live attenuated vaccine (especially against yellow fever) with a recent use.
Combination of the drug with "Cyclosporine" or "Tacrolimus" can lead to the development of severe immunosuppression and attachment of a secondary bacterial infection. You can not prescribe Vinorelbin in the treatment with Itraconazole and Mitomycin C, because this leads to a significant increase in the toxic effect on the central nervous and respiratory systems.
The drug can not be combined with radiotherapy if the latter includes a liver in its therapeutic field. It is proved that this increases the risk of developing an organ failure.
Before and during the treatment with Vinorelbin, hematological control should be performed. With a decrease in the number of neutrophils below 2000 per mm³, the doctor must temporarily postpone the initiation of treatment or suspend the course until the normal blood parameters are restored.
To date, no studies have been conducted to study the safety and efficacy of Vinorelbin in children. Therefore, if possible, give priority to another drug.
The most characteristic side effect of Vinorelbine therapy is the cumulative transient decrease in the number of neutrophils in the peripheral blood. This condition is dangerous by reducing the immune reactivity of the body, especially to bacterial infections. Neutropenia usually goes on itself 5-7 days after the drug is withdrawn.
The drug also has a neurotoxic effect, which is clinically manifested by peripheral neuropathy, a decrease deep reflexes, paresthesias, increased fatigue of limb muscles and the development of constipation (due to paresis intestines). The severity of these symptoms depends on the dose of the drug, and they pass after the completion of treatment.
Sometimes during therapy, there are transient disorders from the digestive system - nausea, vomiting, a feeling of heaviness in the abdomen, flatulence and diarrhea.
Allergic reactions to the drug are most often manifested by symptoms of bronchial obstruction with a dyspnea of the expiratory type. Also, cases of localized or generalized skin rash are described.
With prolonged therapy with Vinorelbin, inflammation can occur in the area of injections, which is accompanied by a burning sensation. In such situations, it becomes necessary to administer the drug through a central venous catheter. In case of mistakes in the method of using the drug, necrosis of soft tissues sometimes developed.
There are also cases of myocardial ischemia, which varied clinically from transient ECG changes to pain in the chest and the development of myocardial infarction.
Patients were also observed who developed alopecia (hair loss) after the course of therapy with Vinorelbin.
What should I look for during the treatment of cancer with Vinorelbine?
Before prescribing the drug, a careful laboratory and instrumental diagnostics of the functional state of the main body systems - excretory, hepatic and hematopoietic. During the treatment, a regular monitoring of the hematological picture, creatinine, urea, ALAT, ASAT, bilirubin, protein, cholesterol and thymol test in the blood is also carried out.
When using Vinorelbine, you should be careful not to get the product directly into your eyes. While there is no information on the presence of a negative impact on the ability to drive vehicles. But driving is not particularly welcome due to the manifestation of side effects of the drug (especially from the central nervous system).
Evaluation of side effects of "Vinorelbin" is carried out only by the attending physician. He is able to assess their severity and potential danger to the patient's health. Also, only the doctor decides whether to continue therapy or to cancel it.
Assistance with overdose
An overdose of a drug appears mainly granulocytopenia or agranulocytosis. This condition is accompanied by the addition of secondary superinfection (mainly bacterial).
Assistance with overdose includes the use of antibiotics. Usually, drugs are selected from the group of cephalosporins, fluoroquinolones, aminoglycosides, carbapenems or glycopeptides. In addition, stimulants of granulocytopoiesis ("Pantohematogen "Glycyram" or granulocyte CSF) are prescribed.
Analogs, the price, where to buy, who is the manufacturer?
"Vinorelbine" is produced by many pharmaceutical concerns and firms under the trade names "Navelbin" (Pierre Fabre Medication Production), Vinorelbin-Vista (Aktavis, Italy), Vinorelsin (Sindan Pharma), Vinor (NV Remediz), Vinelbin (Fresenius Kabi Oncolology).
The price of the drug per bottle 5 ml is 3000-3500, and for the capsule 20 mg - 4600-5200 rubles. Buy "Vinorelbin" can be in the largest pharmacy chains, as well as on the Internet with delivery to the specified address.
The main analogues are preparations "Vincristine" and "Vinblastine" - also alkaloids of periwinkle. However, the application schemes and indications for the appointment are different. "Vinorelbine" is a more specific drug and is used only for certain oncological pathologies..