Vinflunine: review of a new vinca alkaloid and its potential role in oncology

Our plain-English summary of Vinflunine: review of a new vinca alkaloid and its potential role in oncology, by J.S. Ng (Journal of Oncology Pharmacy Practice, 2011).

The study

• Author: J.S. Ng
• Journal: Journal of Oncology Pharmacy Practice
• Published: 2011;17(3):209-24
• Type of article: Review
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To review the pharmacology, pharmacokinetics, in vitro and in vivo efficacy, and safety profile of vinflunine in the treatment of various solid tumors.

Data Sources: A literature search was conducted using keywords included vinflunine, vinca alkaloid, Javlor, and solid tumor in PubMed/MEDLINE (1950-January 2009) and International Pharmaceutical Abstracts (1950-January 2009).

Study Selection And Data Extraction: Published studies, posters, and meeting abstracts evaluating the in vitro and in vivo efficacy of vinflunine were reviewed.

Data Synthesis: Vinflunine is the newest member of the vinca alkaloid family. It has the weakest affinity to tubulins, but is shown to have unique receptor-independent antiangiogenesis, and antimetastasis properties. After administration, it is distributed extensively into tissues, metabolized via the CYP3A4 system, and eventually excreted in urine and feces. Phase II/III trials reported activities of vinflunine in advanced stage nonsmall-cell lung cancer, metastatic breast cancer, metastatic renal cell carcinoma, transitional cell carcinomas of the urothelium, small-cell lung cancer, and malignant pleural mesothelioma as monotherapy and in combination with other chemotherapy agents. More ongoing trials are evaluating its use in other solid tumors and in combination regimens. The most common adverse events in these trials were hematological (anemia and neutropenia), constipation, fatigue, abdominal pain, and myalgia.

Conclusions: Vinflunine is a new vinca alkaloid for the treatment of advanced staged solid tumors. Available data showed promising activities in various malignancies. Further studies are needed to further define vinflunine's role in oncology.

In plain English

This article was a review, not a new study. The author searched two databases (1950 to January 2009) for studies, posters and meeting abstracts on vinflunine, a vinca alkaloid chemotherapy drug, across several advanced cancers. Asbestos was not studied; malignant pleural mesothelioma was described as a disease associated with asbestos exposure. For that disease, the review described one phase II trial by other researchers, in which patients with no previous chemotherapy received vinflunine 320 mg/m2 every 21 days. The text gave 62 patients, while a table listed 67 patients, 62 of them evaluable. The review reported an overall response rate of 13.8% (95% CI 6.5 to 24.7), alongside 9 partial responses (14.5%). Median progression-free survival was 3.2 months (95% CI 2.6 to 4.2) and median overall survival 10.8 months (95% CI 7.8 to 12.0). The most common severe side effects were low neutrophil counts (45%, with no febrile neutropenia) and constipation (9%). Across all reviewed trials, common side effects included anemia, neutropenia, constipation, fatigue, abdominal pain and myalgia. The author concluded the data were promising and more studies were needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Literature review of published studies, posters and meeting abstracts on the drug vinflunine
• Who was studied: Published literature in PubMed/MEDLINE and International Pharmaceutical Abstracts, 1950 to January 2009. For mesothelioma, the review described one phase II trial (Talbot et al.) in patients with malignant pleural mesothelioma and no previous chemotherapy. The text gives 62 patients; Table 1 lists 67 patients, 62 evaluable.
• Exposure: No asbestos exposure was studied. The subject was treatment with vinflunine, a vinca alkaloid chemotherapy drug. In the mesothelioma trial it was given alone at 320 mg/m2 every 21 days.
• Main results:
  • In the reviewed phase II mesothelioma trial (patients with no previous chemotherapy), the review reported an overall response rate of 13.8% (95% CI: 6.5–24.7).
  • In the same trial, the review gave 9 patients (14.5%) with a partial response and 35 (56.5%) with stable disease. The 14.5% figure does not match the 13.8% overall response rate.
  • In the same mesothelioma trial, median progression-free survival was 3.2 months (95% CI: 2.6–4.2) and median overall survival was 10.8 months (95% CI: 7.8–12.0).
  • In the mesothelioma trial, the most common grade 3/4 toxicities were neutropenia (45%, with no febrile neutropenia) and constipation (9%).
  • In a reviewed phase III trial in previously treated non-small-cell lung cancer, survival with vinflunine was similar to survival with docetaxel: median overall survival was 6.7 versus 7.2 months, with a hazard ratio of 0.973 (95% CI: 0.805–1.176).
  • Across the reviewed trials, the most common adverse events were hematological (anemia and neutropenia), constipation, fatigue, abdominal pain and myalgia.
• The authors' conclusion: The author concluded that available data showed promising activity of vinflunine in various cancers and that further studies are needed to define its role. For malignant pleural mesothelioma, the author wrote that vinflunine seems to be a new option with promising results.
• Limitations the authors state:
  • Some of the reviewed results came from interim reports that had no statistical analysis.
  • Many of the combination studies reviewed were small phase I–II single-arm trials.
  • Data on the detailed metabolism of vinflunine are limited.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Carcinoma, Pleural Mesothelioma, Chemotherapy, Neutropenia.

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