Treatment with Vinorelbine for Relapsed Pleural Mesothelioma

A new study suggests that treatment with vinorelbine may boost progression free survival for people with relapsed malignant mesothelioma.

Mesothelioma is a virulent cancer caused by exposure to asbestos. Chemotherapy is the primary first-line treatment. But this cancer almost always comes back within a few months. 

Now, researchers at the UK’s University of Leicester say treatment with vinorelbine might keep mesothelioma at bay for several months longer. They presented their research at this months’ annual meeting of the American Society of Clinical Oncology. 

Second-Line Mesothelioma Treatments Needed

Pleural mesothelioma is the most common form of mesothelioma. Tumors grow on the membrane around the lungs. The symptoms often mimic lung cancer but can be even more deadly. 

Some of the healthiest mesothelioma patients qualify for surgery. Others may be candidates for newer immunotherapy treatments, if available. 

But most people with mesothelioma have to stick with chemotherapy. The standard-of-care for mesothelioma is a combination of Alimta (pemetrexed) and cisplatin. For most patients, the treatment only slows down the spread of the disease. 

The UK research suggests that treatment with vinorelbine could be an option when mesothelioma recurs. Right now, there is no approved second-line mesothelioma treatment. 

Vinorelbine is a plant alkaloid made from the periwinkle plant. It fights cancer by interfering with cell division. Doctors already use vinorelbine with several other recurrent cancers, including non-small cell lung cancer. One up-side to this drug is that it does not usually cause many side effects. 

The Promise of Treatment with Vinorelbine

To test the value of treatment with vinorelbine, researchers recruited 154 patients with recurrent pleural mesothelioma. Patients came from ten UK hospitals between May 2016 and October 2018. 

Ninety-eight patients were randomly assigned to receive treatment with vinorelbine along with active symptom control (ASC). Patients received an oral dose once a week for 21 days. Then they got a higher dose for the next two months. The remaining 56 patients received only ASC. 

Both sets of patients lived about nine months. But there was a clear difference in their response to treatment. Mesothelioma patients who received treatment with vinorelbine had a partial response rate of 3.1% compared to 1.8% in the active supportive care group. 

The stable disease rate in the vinorelbine group was 62.2% and the response lasted for a median of 7.2 months. In contrast, the ASC group had a response rate of just 46.4% with a median response duration of just 4.2 months. 

Not surprisingly, there were more side effects among the mesothelioma patients receiving treatment with vinorelbine. About 12% had low white blood cell counts, 6.2% had shortness of breath, and 4.2% complained of fatigue. 

Primary investigator Dean A. Fennell, FRCP, PhD, chair of thoracic medical oncology at the University of Leicester, told ASCO attendees that the evidence was solid enough to justify using vinorelbine for relapsed mesothelioma. 

“Vinorelbine demonstrates useful clinical efficacy in relapsed MPM, supporting its off-label use, as a treatment option for patients with relapsed MPM,” his report concludes. 

Source:

Fennell, DA, et al, “A randomized phase II trial of oral vinorelbine as second-line therapy for patients with malignant pleural mesothelioma”, Abstract presentation, ASCO 2021, https://meetings.asco.org/abstracts-presentations/196657