Vinorelbine — Drug Monograph

Brand names: Navelbine

Drug class: Vinca Alkaloid

Mechanism of Action

Semisynthetic vinca alkaloid derived from vinblastine. Inhibits microtubule polymerization by binding to tubulin, blocking mitosis at metaphase. Preferentially depolymerizes mitotic spindle microtubules over axonal microtubules (compared to other vinca alkaloids) — results in relatively less neurotoxicity than vincristine.

FDA Indications

• Non-small cell lung cancer (NSCLC) — first-line (alone or with cisplatin)
• Advanced breast cancer — second-line (as single agent or in combination)

Common Side Effects

• Myelosuppression (granulocytopenia is dose-limiting)
• Peripheral neuropathy (less than vincristine)
• Constipation, nausea
• Fatigue, asthenia
• Injection site reactions (phlebitis)
• Alopecia (mild)

Clinical Pearl

Vinorelbine causes significantly less neurotoxicity than vincristine because its catharanthine moiety preferentially binds axonal rather than mitotic microtubules — the opposite of vincristine. This makes it better tolerated for elderly patients with baseline neuropathy.

Related Therapies & Mechanisms

• Atezolizumab (Tecentriq) — NSCLC
• Carboplatin (Paraplatin) — Breast
• Datopotamab deruxtecan-dlnk (Datroway) — Breast
• Docetaxel (Taxotere) — Breast