Vinorelbine

Vinorelbine, sold under the brand name Navelbine among others, is a semi-synthetic vinca alkaloid chemotherapy agent derived from vinblastine. It is used to treat several cancers, most notably non-small cell lung cancer and metastatic breast cancer.

Vinorelbine works by binding to tubulin and inhibiting microtubule polymerization. This disrupts the formation of the mitotic spindle, preventing cells from progressing through metaphase and leading to cell cycle arrest and apoptosis. The drug is part of a class of anti-mitotic agents and is considered a microtubule inhibitor.

Clinically, vinorelbine is approved for non-small cell lung cancer as monotherapy or in combination with cisplatin, and for metastatic breast cancer. It is administered by intravenous infusion, with dosing based on body surface area and the chosen regimen. Common schedules include weekly or every three weeks, depending on the indication. Intrathecal administration is contraindicated; the drug should be given only by the IV route.

Pharmacology and safety: Vinorelbine is primarily metabolized in the liver (notably by CYP3A4) and is eliminated via hepatic pathways, so dose adjustments are needed in hepatic impairment. Interactions with strong CYP3A4 inhibitors or inducers can alter exposure. Adverse effects commonly include neutropenia, leukopenia, anemia, nausea, vomiting, constipation, fatigue, and elevated liver enzymes. Neurotoxicity and mucositis may occur but are generally less severe than with some other vinca alkaloids. Serious hypersensitivity reactions can occur during infusion, so patients are monitored for infusion-related events.