Vinorelbine (Navelbine)

Vinorelbine is a chemotherapy drug used to treat breast cancer and non small cell lung cancer. It belongs to the group of drugs called vinca alkaloids. These are often called plant alkaloids because the first of these drugs was developed from the periwinkle plant (vinca). These drugs are sometimes called microtubule inhibitors. This describes the way they work in damaging cancer cells. Vinorelbine works by stopping the cancer cells from separating into two new cells. So it blocks the growth of the cancer.

Vinorelbine is a pale yellow liquid that you have by injection through a fine tube (cannula) put into a vein (intravenously). Or you may have it through a central line, a portacath or a PICC line. These are long tubes that give the drug into a major vein near your collarbone. The tube is put in before your course of treatment and stays in as long as you need it.

Vinorelbine also comes as capsules of 20mg, 30mg and 80mg that you swallow with plenty of water, and preferably with something to eat. Don't chew or suck the capsules, because the drug could make your mouth sore if it leaks out. If you do this accidentally, rinse your mouth out over and over again with clean water and contact your doctor as soon as possible.

You usually have vinorelbine chemotherapy as a course of several cycles of treatment. The treatment plan depends on which type of cancer you have. There is more about how doctors plan chemotherapy in the chemotherapy section.

Vinorelbine side effects are listed below. You can use the links to find out more about each side effect or go to the cancer drug side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your hospital if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
• Constipation can be a problem in about 1 in 3 people (30%) but is generally prevented with regular laxatives – if you are constipated for more than 3 days, tell your doctor or nurse
• Feeling or being sick is usually moderate, is most likely to come on within the first 24 hours after treatment, and is easily controlled with anti sickness injections and tablets - do tell your doctor or nurse if your sickness is not controlled as you can try other anti sickness medicines
• Vinorelbine can cause pain along the vein where you have the injection – tell the person giving the drug as they can help by flushing the drug through with more fluid
• Vinorelbine can cause darkening or discoloration of the vein where you have the injection
• Diarrhoea occurs in up to 1 in 5 people (20%) but is usually controlled with anti diarrhoea tablets
• Hair loss, or more usually thinning, happens to about 1 in 10 people (10%)
• Sore mouth or mouth ulcers
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with vinorelbine, so talk to your doctor about your fertility before starting treatment if having a baby is important to you
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Vinorelbine may harm a developing baby so it is not advisable to become pregnant or father a child if you are having this drug – talk about contraception with your doctor or nurse before having the treatment if there is any chance you or your partner could become pregnant
• You should not breastfeed while having this drug as it may come through in the breast milk

Between 1 and 10 in every 100 people have one or more of these.

• Temporary numbness and tingling in fingers and toes (peripheral neuropathy) can happen but is usually mild with this drug
• Inflammation around the drip site – if you notice any signs of redness, pain, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately

Very occasionally, someone has an allergic reaction to this drug. Tell your doctor or nurse straight away if you have a sudden cough, wheezing or difficulty breathing after having vinorelbine.

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.