Efficacy and safety of metronomic oral vinorelbine in elderly patients with locally advanced and metastatic non-small cell lung cancer

Lung cancer remains one of the most frequently diagnosed malignancies and the leading cause of cancer-related mortality globally. Metronomic chemotherapy (MC) enables prolonged low-dose treatment administration with lower toxicity while maintaining therapeutic efficacy. Our goal was to assess the efficacy and safety of oral vinorelbine (OV) administered in a metronomic schedule in elderly patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). Patients & methods This single-center study was conducted at the Clinical Oncology Department of Suez Canal University Hospital. The study included elderly patients (aged ≥ 60 years) with locally advanced or metastatic NSCLC (TNM stage IIIB/IV) who had previously received first-line platinum-based chemotherapy with or without concomitant chemoradiotherapy. All patients were confirmed to lack sensitizing EGFR mutations as well as ALK and ROS1 rearrangements, irrespective of PD-L1 expression status and were treated between January 2020 and October 2024. The study population consisted of histopathologically-proven patients who fulfilled the inclusion and exclusion criteria. Patients received metronomic OV at fixed doses (30, 40, or 50 mg three times weekly) until disease progression or development of unacceptable toxicity. Results From January 2020 to October 2024, 50 patients were included: 39 men (78%) and 11 women (11%). The median age was 67 years. The predominant histological subtype was squamous cell carcinoma (44%). The duration of OV therapy ranged from 6 to 18 months, with a mean of 9.16 ± 3.6 months. Patients received 8 to 24 cycles, with a mean of 11.74 ± 4.44. According to RECIST criteria, the disease control rate was 78% after 6 months, while the overall response rate was 64%. No grade 4 or 5 adverse events were observed. The mean progression-free survival (PFS) was 13.74 months (95% CI: 12.11 to 15.36), whereas the mean overall survival (OS) was 19.67 months (95% CI: 17.85 to 21.49). Comparison of EORTC QLQ-C30 quality-of-life (QoL) scores before treatment and after 6 months of OV therapy demonstrated improvement in patients' functioning and QoL. Conclusion Metronomic OV demonstrated clinical efficacy in elderly patients with advanced wild-type NSCLC. It was associated with a significant reduction in toxicity and may represent a valuable therapeutic option for this age group, with excellent treatment compliance.