Oral vinorelbine-based concomitant chemoradiotherapy in unresectable stage III non-small cell lung cancer: a systematic review

ABSTRACT

Introduction: Cisplatin-based chemotherapy administered concomitantly to thoracic radiotherapy is the treatment recommended by the European guidelines for fit patients with unresectable stage III non-small cell lung cancer (NSCLC). Cisplatin may be combined with etoposide, vinorelbine or other vinca alkaloids, which act also as radiation sensitizers. Initially administered intravenously, vinorelbine is also available as oral formulation and is the only orally available microtubule-targeting agent. In addition, the oral formulation avoids the risk of extravasation and phlebitis.

Areas covered: A literature search has been performed for articles reporting phase II–III trials aimed to evaluate efficacy and safety of oral vinorelbine-based chemoradiotherapy in unresectable locally advanced NSCLC.

Expert commentary: In a series of trials with various protocols published from 2008 to 2018, mostly phase II studies, oral vinorelbine demonstrated a significant activity in concomitant chemoradiotherapy for unresectable locally advanced NSCLC typically as part of combination schedules with cisplatin. Main toxicities were hematologic (neutropenia and anemia); non-hematological toxicities included esophagitis and gastro-duodenal adverse events. Large prospective phase III trials are needed to confirm the role of vinorelbine-based chemotherapy associated to thoracic radiotherapy in unresectable stage III NSCLC and more particularly trials with metronomic oral vinorelbine.

KEYWORDS:

• Non-small cell lung cancer
• unresectable lung cancer
• locally advanced lung cancer
• chemoradiotherapy
• vinorelbine

Acknowledgments

The authors thank Francis Beauvais (independent medical writer funded by Pierre Fabre Oncology) for providing medical writing support.

Declaration of interest

In the past 5 years, C Chouaid has received fees for attending scientific meetings, speaking, organizing research or consulting from Pierre Fabre Oncology; A Vergnenegre received fees for attending scientific meetings, speaking, organizing research or consulting from Pierre Fabre Oncology; I Martel-Laffay and C Locher received fees for organizing research from Pierre Fabre Oncology; R Schott received fees for attending scientific meetings and speaking from Pierre Fabre Oncology. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Pierre Fabre Oncology provided financial support for medical writing assistance. This manuscript was also supported by a grant from the French Group of Lung Cancer (GFPC) Formation.