A case of recurrent lung cancer successfully treated using ambulatory chemotherapy with vinorelbine

The patient was a 64-year-old woman. She had previously suffered from stage IA lung adenocarcinoma and undergone a right upper lobe resection. After 7 years, she complained of coughing and right chest pain. Right pleural effusion and tumor mass shadow/lymph node swelling on the surgical margin of a right bronchus were found. A tumor marker (CEA) was also at a high level. Combination chemotherapy with cisplatin (CDDP) and docetaxel (TXT) failed to produce an antitumor effect. The treatment was changed to ambulatory chemotherapy with vinorelbine (VNB) at 20 mg/m2 weekly. This produced tumor reduction and disappearance of the pleural effusion, and normalized the CEA level. No adverse reactions except leukopenia of grade 2 occurred. VNB alone seemed to successfully exhibit an antitumor effect. As VNB is easy to administer, it will be applicable in ambulatory chemotherapy administered with consideration of the patients quality of life.     

A case of non-small-cell lung cancer successfully treated using combination chemotherapy with CDDP and vinorelbine

A 67-year-old woman presented to our hospital with a chief complaint of bloody sputum. A plain chest X-ray a CT scan revealed a tumor shadow 3 cm in size in the middle lobe of the right lung, multiple nodular shadows in the bilateral lung fields and enlarged hilar and mediastinal lymph nodes. A tumor biopsy done under bronchoscopy revealed poorly differentiated adenocarcinoma of the lungs (cT2N3M1). She was given two courses of combination therapy consisting of cisplatin (80 mg/m2) and vinorelbine (20 mg/m2). The primary tumor in the middle lobe of the right lung and the lung metastases were markedly reduced in size, and a complete response was obtained. The only adverse events were grade 4 neutropenia and grade 2 nausea and vomiting.     

A case of elderly advanced squamous cell lung carcinoma successfully treated with nedaplatin and S-1 combination chemotherapy

A 7 4-year-old male was referred to our hospital for an abnormal chest shadow pointed out by a medical examination. A chest computed tomography revealed a tumor shadow 39 X 32mm in size in his left upper lobe in January, 2010. Pathological examination of biopsy specimens showed squamous cell carcinoma of the lung. Although there was no distant metastasis, multiple metastases to mediastinal lymph nodes was noted. He was diagnosed as Stage III A(cT2aN2M0). Considering his age and the histology of the disease, systemic chemotherapy with nedaplatin and S-1 was performed. The diameter of the primary lesion was decreased from 39mm to 18mm after 4 courses of chemotherapy, and was considered as partial response (PR)according to the RECIST criteria. The adverse events were grade 2 appetite loss, grade 3 neutropenia, and grade 2 thrombocytopenia. Recently, various new agents for treating non-squamous cell lung carcinoma have been developed, but there has been little progress in the treatment of squamous cell lung carcinoma. We experienced a patient with advanced squamous cell lung carcinoma who responded with CDGP/S-1 combination chemotherapy. We are now conducting a phase I / II clinical study to verify the usefulness of this regimen against advanced squamous cell lung carcinoma.     

A case of large-cell lung cancer with liver metastasis successfully treated using combination chemotherapy with CDDP and vinorelbine

A 38-year-old woman presented to our hospital with the chief complaint of dyspnea. A chest radiograph showed pleural effusion of the right lung and a CT scan revealed liver metastasis. A tumor biopsy done under bronchoscopy revealed large-cell carcinoma of the lungs. She was given 4 courses of a combination therapy consisting of CDDP (80 mg/m2) and vinorelbine (25 mg/m2). The primary tumor in the right lung and liver metastasis were markedly reduced in size and a partial response was obtained. The combination therapy of CDDP and vinorelbine may become a standard chemotherapy for advanced non-small cell lung cancer.     

A case of elderly non-small-cell lung cancer (NSCLC) treated in cooperation with a local hospital and with vinorelbine monotherapy

We report an elderly advanced NSCLC patient effectively treated with vinorelbine on an outpatient basis in cooperation with his family doctor. A 79-year-old man was referred to our hospital for evaluation of a nodular shadow in his right lung. Chest CT scan showed a 2.0 cm tumor shadow in right S1, and small nodular shadows in right S4 and left S5. Neck lymph node biopsy yielded a diagnosis of adenocarcinoma. The clinical stage was IV, and he underwent chemotherapy of vinorelbine 25 mg/m2 on days 1 and 8. The regimen opted for a setup of a schedule, while the dose of vinorelbine and evaluation by CT were done in our hospital. This regimen was well tolerated and suitable. The patient could receive long-term continuation of the chemotherapy medication, and showed improvement in terms of prolongation of life and QOL.     

A case of endobronchial squamous cell lung cancer successfully treated with weekly chemotherapy of carboplatin and paclitaxel

A 69-year-old man had undergone low anterior resection and a right lobe resection of the liver for rectum cancer and metastatic liver tumor at the age of 66 years. He presented at our hospital because of an abnormal shadow on a CT chest scan, which indicated a tumor shadow 2.5 cm in size in the lingular lobe and enlarged hilar and mediastinal lymph nodes. A bronchoscopic tumor biopsy revealed pulmonary metastasis from the rectum cancer. Bronchoscopic examination also identified an endobronchial squamous cell lung cancer, which almost completely obstructed the orifice of B1 and B2. We concluded that the patient had squamous cell lung cancer with metastases in the mediastinal lymph nodes. He was initially treated with weekly chemotherapy with carboplatin (AUC 1.25) and paclitaxel (70 mg/m2). The endobronchial tumor was markedly reduced in size after 2 weeks of the chemotherapy. Furthermore, after 6 weeks of the chemotherapy, the tumor had disappeared completely, and 11 days later, lower division segmentectomy and hilar and mediastinal lymph node dissection were performed. Pathological examination revealed no metastases in the lymph nodes. The patient has continued to receive chemotherapy as an outpatient and has been well without recurrence of any metastases for over 16 months.     

A case of recurrent lung cancer successfully treated with vinorelbine and cisplatin

A 56-year-old female underwent lobectomy with ND2a lymph node dissection for left lung cancer in April 1999. Histopathological examination demonstrated moderately differentiated adenocarcinoma (pT2N2M0, stage III A). She received one course of a combination of etoposide and cisplatin as adjuvant therapy, followed by oral intake of UFT. In November 1999, a left para-aortic lymph node recurrence was found. She received radiation therapy (total 60 Gy) to the mediastinum. In April 2000, new lung and left supraclavicular lymph node recurrences were found. She received three courses of vinorelbine 20 mg/m2 (days 1, 8) and cisplatin 80 mg/m2 (day 1) followed by radiation therapy (total 50.4 Gy) to the left supraclavicular lesion. After the chemotherapy, a complete response (CR) of all metastatic lesions was achieved. Adverse reactions were grade 1 alopecia, grade 2 nausea/vomiting, grade 3 neutropenia, hypochromia, and injection site reaction. The combination of vinorelbine and cisplatin is a useful regimen in non-small-cell lung cancer.     

A case of bronchial stump recurrence of lung cancer successfully treated with chemoradiotherapy using cisplatin plus vinorelbine

A 61-year-old man, who had undergone right upper lobectomy for lung cancer about nineteen months earlier, was examined at our hospital for hemoptysis. A bronchial stump recurrence was observed by chest CT and bronchoscopy. The patient underwent chemoradiotherapy using cisplatin (CDDP) and vinorelbine (VNB). Irradiation was started (total 60 Gy/30 fr/6 weeks) about four weeks before the onset of chemotherapy. Chemotherapy consisted of 2 cycles of CDDP 80 mg/m2 on day 1 and VNB 15 mg/m2 on day 1, 8. The dose of VNB was increased to 25 mg/m2 during cycle 2 because cycle 2 was without radiotherapy. After the chemoradiotherapy, the recurrent tumor disappeared on a CT scan and bronchoscopy. Chemoradiotherapy using CDDP plus VNB regimen is considered effective, without serious side effects for advanced non-small-cell lung cancer.     

A case of recurrent lung cancer successfully treated with vinorelbine and cisplatin/carboplatin

A 73-year-old male underwent lobectomy with ND2a lymph node dissection and resection of the superior vena cava for right lung cancer in December 1998 at Akita University Hospital. Histopathological examination demonstrated moderately differentiated adenocarcinoma (pT4 (SVC) N2M0, Stage IIIB). He received 1 course of a combination of cisplatin (CDDP) and etoposide (ETP) as postoperative adjuvant therapy. In March 2001, he again underwent partial resection of the right lung (S8) due to recurrence. In December 2001, a new left lung metastatic tumor was found. The patient was transferred to our hospital, where he was given 1 course of vinorelbine (NVB) 25 mg/m2 (day 1, 8) and CDDP 80 mg/m2 (day 1). Subsequently, he received 2 courses of vinorelbine (NVB) 25 mg/m2 (day 1, 8) and carboplatin (CBDCA) 430 mg/body (day 1). After the chemotherapy, a complete response (CR) of metastatic lesions was achieved. Adverse reactions were grade 3 neutropenia, grade 2 alopecia and grade 1 nausea/vomiting. The combination of vinorelbine and platinum agent (CDDP/CBDCA) is a useful regimen in treating recurrent non-small-cell lung cancer.     

参芪扶正注射液联合化疗治疗非小细胞肺癌的临床观察

目的:比较参芪扶正注射液联合化疗与单纯化疗治疗非小细胞肺癌的临床疗效及不良反应.方法:60例非小细胞肺癌患者随机分为参芪扶正注射液配合化疗组(治疗组)和单纯化疗组(对照组) ,其中配合化疗组30例,采用紫杉醇135mg/m2+生理盐水500ml静滴3小时以上,第1天,后予顺铂25mg/m2静滴,第1 -3天方案化疗,化疗时常规行预处理,化疗前3天开始静滴参芪扶正注射液250ml,1次/日,连用10天,每21天为1周期.对照组30例化疗方案同治疗组,至少2个周期后评价疗效及生存质量改善情况.结果:参芪扶正注射液配合化疗组总有效率(40.0%)较单纯化疗组(33.3%)高,但差异无统计学意义(P＞ 0.05) ,但在改善患者生活质量、减轻化疗毒性方面明显优于单纯化疗组,差异有显著性(P＜ 0.05) .结论:参芪扶正注射液联合化疗在治疗非小细胞肺癌中可提高化疗疗效,减轻化疗毒性,提高患者生活质量.     

Induction chemotherapy (cisplatin + vinorelbine) is found to be markedly effective for squamous cell lung carcinoma with sarcoidosis--a case report

A sixty-one-year-old man was admitted to our hospital because of a right lung tumor shadow. He had been diagnosed as having sarcoidosis at the age of fifty-seven. He was newly diagnosed as having squamous cell carcinoma by trans bronchial biopsy. He was treated with an induction chemotherapy (cisplatin 80 mg/m2 + vinorelbine 20 mg/m2) followed by right middle and lower lobectomy with a mediastinal nodal dissection, because the stage of his carcinoma was cT2N2M0. Resected lung tissue showed the disappearance of cancer cells. Dissected mediastinal and hilar lymph nodes showed many sarcoid granulomas. Cisplatin combined with vinorelbine might be an effective chemotherapy for non-small cell lung carcinoma.     

A case of docetaxel-resistant lung cancer effectively treated with chemotherapy of gemcitabine and vinorelbine

We report a NSCLC patient effectively treated with anti-cancer agents on an outpatient basis despite chemotherapy with carboplatin and docetaxel, he relapsed after achieving a transient response. Combination chemotherapy with gemcitabine and vinorelbine administered every three weeks in an outpatient clinic caused the lung cancer volume to reduce remarkably. This regimen was well tolerated and suitable for outpatients. Its usefulness as a second line chemotherapy in the treatment of NSCLC should be investigated.     

Accelerated neoadjuvant chemotherapy of non-small cell lung cancer (NSCLC)

Thirty patients with marginally resectable stage IIIA or stage IIIB NSCLC were treated with cisplatin (80 mg/ m(2)/i.v./dl), ifosfamide (4,000 mg/m(2)/i.v./dl) and vinorelbine (30 mg/m(2)/i.v./dl) plus G-CSF 300 mu g/s.c. on days 7-12 every 14 days for three cycles before surgery. In 26 evaluable patients, the radiographically assessed response rate to chemotherapy was 77% (8% complete). Three septic deaths (10%) occurred in spite of G-CSF and 1 patient refused to continue after the first cycle. Thoracothomy was performed in 23 patients including 19 complete resections. At 15 months median follow-up (range 10-22+), 11/19 (57%) completely resected patients relapsed. The overall median time to treatment failure was 11 months (range 0-17). Actuarial survival probability at 12, 18 and 24 months are 56%, 43% and 36%, respectively. In conclusion, the combination of cisplatin, ifosfamide and vinorelbine in full doses at a 14 day interval (accelerated chemotherapy) was very effective in neoadjuvant NSCLC setting. Nevertheless, relevant toxicity was demonstrated with a 10% death rate probably due to the overlapping toxicity of chemotherapy cycles, suggesting the need for a more intense supportive care or longer interval between cycles.     

Assessment of functional status,symptoms and comorbidity in elderly patients with advanced non-small-cell lung cancer (NSCLC) treated with gemcitabine and vinorelbine

Abstract Background: The incidence and prevalence of comorbid conditions in lung cancer patients increase with age. The aim of the study was to determine response and tolerability with the biweekly combination gemcitabine–vinorelbine in elderly non-small-cell lung cancer (NSCLC) patients. In order to characterise the population included in the study well and assess the results achieved properly, an evaluation of the functional status, comorbidity and survival was performed. Patients and method: Between June 2001, and December 2003, 59 untreated advanced NSCLC patients over the age of 70 years entered the study. Treatment consisted of gemcitabine 1750 mg/m² and vinorelbine 30 mg/m² on day 1 every two weeks. The response was evaluated every f ive cycles (RECIST guidelines). Comorbidity was evaluated according to the Charlson and Kaplan Feinstein scales. To measure functional status, activities of daily living (ADL) and instrumental ADL (IADL) were considered. Results: Median age was 74; ECOG performance status was <2 in 59.3%; no dependence in ADL or IADL was found in 24.8% and 42.4% of patients, respectively. A total of 381 courses were administered. Grade 3–4 neutropenia was present in 6.8% of these courses and correlated with IADL. Objective response was 22% (95% CI 12–32). Mean global survival and cause-specific survival were 29 weeks (95% CI 19.9–38.1) and 32 weeks (95% CI 23.4–40.8) respectively. Comorbidity displayed no close correlation with functional status, but comorbidity according to the Kaplan Feinstein index correlated with IADL. Performance status, ADL, IADL and weight loss were significantly related to survival in multivariate analysis. Conclusions: This biweekly combination is feasible in elderly lung cancer patients with a high burden of comorbidity and dependence. Toxicity is acceptable, whereas response rate and survival fall in the range of active regimens. ADL and IADL indices allow the identification of elderly patients with a worse prognosis.     

Successful treatment with chemotherapy of vinorelbine and gemcitabine for an elderly patient with advanced non-small cell lung cancer

A 74-year-old man with non-small cell lung cancer was referred to our hospital for chemotherapy. On admission, he suffered from high fever and left upper back pain. Laboratory data showed marked leukocytosis and increased CRP. He was treated with chemotherapy of weekly vinorelbine and gemcitabine. After the second cycle, the levels of leukocytes and CRP were remarkably decreased, and the severe back pain was also alleviated. He has been given an additional 4 cycles as an outpatient. He is now doing well. This regimen seems to be effective in alleviating symptoms and improving QOL.     

A case of recurrent esophageal cancer with lung metastases successfully treated with docetaxel-combination chemotherapy

We report a case of a 67-year-old woman diagnosed with advanced esophageal cancer. She was treated with chemo-radiotherapy (5-FU/CDDP therapy and irradiation) initially, and primary lesion was well controlled.Two and a half years after first treatment, a chest CT showed multiple lung metastasis, which were confirmed by thoraco-laparoscopy. We chose docetaxel/CDDP combination chemotherapy, because of severe side effects due to the first treatment. After 3 courses, lung metastatic lesions were reduced. The following courses combining docetaxel-nedaplatin were done as ambulatory treatment. These regimens could be one choice for recurrent esophageal cancer, especially FP therapy-resistant or intolerant cases.     

A case of squamous cell lung cancer in a nonsmoking female, successfully treated with docetaxel and cisplatin

A 62-year-old nonsmoking female was admitted to our hospital in May, 1998 complaining of marked cough accompanied by repeated hemosputa. Chest X-ray and CT examinations revealed a large tumor, located adjacent to a cystic lesion in the left lower lung field, in association with a clearly recognizable swelling of the ipsilateral hilar as well as the mediastinal lymph nodes. Sputum cytology after bronchofiberscopy led to the diagnosis that the patient suffered from squamous cell lung cancer of Stage IIIA with bulky N2 (T2N2M0). Chemotherapy was selected as the most reasonable treatment for this patient. The new chemotherapeutic agent docetaxel (60 mg/m2) in combination with cisplatin (CDDP: 80 mg/m2) was tried, resulting in a remarkable reduction in tumor size by 60% after the initial course of chemotherapy was completed, which fulfilled the definition of a partial response (PR). Furthermore, after 4 courses of the chemotherapy, the hilar and mediastinal lymphadenopathy had conspicuously abated and only scar tissue was visible at the site where the lung cancer was thought to have originally developed. We herein report a case in which squamous cell lung cancer sprouted in a nonsmoking female, who was successfully treated by the combined chemotherapy of docetaxel and CDDP. The present case may suggest the efficacy of newly developed docetaxel in treating non-small cell lung cancer.     

Cisplatin and vinorelbine as second-line chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) resistant to taxol plus gemcitabine

The aim of the study was to evaluate the activity of cisplatin (CDDP) plus vinorelbine (VNR) in patients with advanced non-small cell lung cancer (NSCLC) progressing after paclitaxel plus gemcitabine. Treatment consisted of CDDP 80 mg/m(2) administered on day 1 and VNR 25 mg/m(2) administered on day 1 and 8, repeated every 3 weeks. Nine patients who relapsed after partial response and eight patients refractory to prior CT received a minimum of two treatment cycles: three patients achieved a PR (18%; 95% CI: 4-43%), four had stable disease and 10 had disease progression. All responses were observed among the nine patients responsive to prior treatment. Median survival was 35 weeks. No patients required dose-reduction, treatment discontinuation or delay because of toxicity. Our results indicate a reasonable antitumor efficacy and no relevant toxicity of a second-line CDDP-based chemotherapy in patients with advanced NSCLC. We recommend the use of this regimen for patients not refractory to primary treatment.     

Non-small-cell lung cancer (NSCLC): chemotherapy in advanced disease. Our experience in ten years.

This is a review of the therapeutic schedules used in our service during the past 10 years for the therapy of advanced non-small-cell lung cancer. During the first years, nonrandomized trials were conducted and several combinations were tested: MACC (methotrexate, doxorubicin, cyclophosphamide, and CCNU), cisplatin-etoposide, and cisplatin-vindesine. The results of these trials were invariably discouraging: objective responses hardly reached 30%, while the survival was around 15 months in the best case. On December 1985 a new randomized trial, based on the combination MIP (mytomicin, ifosfamide, cisplatin) was designed; 60.7% of objective responses were achieved, with 9 complete remissions (17.6%) and 22 partial remissions (43.1%). Median survival was 15 months. In order to reduce the toxicity of this combination, carboplatin was substituted for cisplatin. Unfortunately, results were very poor. No complete remission, and only 5 partial responses (20%) were achieved. At the present time, a new randomized trial is being conducted. In it, MIP combination is compared with VIP (vindesine, ifosfamide, cisplatin). Preliminary results have shown no differences between both arms in response, toxicity, or survival. New therapeutic approaches, as neoadjuvant therapy, are being explored.     

Non-small-cell lung cancer in elderly patients: influence of age on vinorelbine oral pharmacokinetics

The majority of cancer-related deaths are attributed to lung carcinoma. Age increases this incidence, which is also likely associated with physiologic modifications that affect drug pharmacokinetics and metabolism. Therefore, knowledge of pharmacokinetics in elderly patients is one of the major factors in deciding whether or not to reduce the dose to prevent toxicity. This phase II study was aimed at evaluating the influence of age on oral vinorelbine pharmacokinetics in elderly patients with non-small-cell lung cancer (NSCLC). Inclusion criteria were > 70 years of age; histologically or cytologically proven NSCLC; inoperable stage IIIB, IV, or delayed relapse of any stage becoming unresectable; Karnofsky performance status > 80%; and normal hematology and biochemistry. Blood-limited sampling at intervals of 1.5, 3, and 24 hours after dosing was performed during the first administration of oral vinorelbine at 60 mg/m2. Bayesian pharmacokinetic parameters were calculated through previously published nonlinear mixed-effect modeling (NONMEM), and compared with a reference population of 52 patients (age, 56 years 12) selected from vinorelbine pharmacokinetic database. There were 48 patients evaluable for pharmacokinetics out of the 52 elderly patients enrolled (age, 74 years 3). There was no difference between pharmacokinetic parameters, including the bioavailability factor evaluated by NONMEM, even without intravenous administration, and a similar interindividual variability (32%-33%) was observed between the 2 groups. Furthermore, no correlation between age (range, 31-82 years) and oral vinorelbine total clearance was observed in 100 patients pooled together. Therefore, no requirement for oral vinorelbine dose reduction was suggested from a pharmacokinetic standpoint.