Vinorelbine and cisplatin (VP) chemotherapy
The chemotherapy drugs used are:
vinorelbine, which is also known as Navelbine®
cisplatin, which is a platinum-based drug.
Vinorelbine and cisplatin chemotherapy is sometimes known as VP (or NP) chemotherapy, named after the initials of the two drugs.
How the treatment is given
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Vinorelbine and cisplatin chemotherapy can usually be given to you as a day patient. Before you start treatment you'll need to have a blood test, either on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. You'll also have tests to check how well your kidneys are working, as the chemotherapy can affect them. These may include collecting your urine for 24 hours or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but this shouldn't last long.
Some people have their chemotherapy given through a fine, plastic tube that is inserted under the skin and into a vein near their collarbone (central line) or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula or line, which is connected to a drip. Some anti-sickness medicines are given as tablets.
The chemotherapy drugs are then given separately:
Vinorelbine (a colourless or very pale yellow fluid) is given as a drip (infusion) into your cannula or line. This takes about 5–10 minutes. Vinorelbine is also available as capsules.
Cisplatin (a colourless fluid) is given as an infusion over about two hours.
Before and after treatment with cisplatin, you'll be given plenty of fluid through the drip to keep your kidneys working normally. This is because cisplatin can sometimes damage the kidneys.
Altogether, your treatment will take 8–12 hours. If you're having your treatment as a day patient you can then go home. The cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for your next cycle of chemotherapy. You'll be shown how to look after the line.
You'll be given a supply of anti-sickness drugs to take home with you. It's important to take these as directed, even if you aren't feeling sick, as some anti-sickness drugs are better at preventing sickness than at stopping it once it has started.
How often the treatment is given
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Your doctor may use the word 'regimen' (eg the VP regimen) when talking about your chemotherapy. This means the whole plan or schedule of the chemotherapy treatment you're being given.
VP chemotherapy can be given in different ways. Below are descriptions of two different schedules. You can ask your doctor or nurse to tell you whether you are having one of these. If not, they will be able to give you details of your regimen.
On the first day of your treatment (day one), you'll be given vinorelbine and cisplatin as described. One week later (day eight), you'll be given the vinorelbine again. This is followed by a rest period of two weeks. This completes what is called a cycle of chemotherapy. Each cycle lasts for three weeks (21 days).
You will start the next cycle of your treatment after the rest period.
On the first day of treatment (day one), you'll be given vinorelbine and cisplatin as described. One week later (day eight), you'll be given the vinorelbine again. This is followed by a rest period of three weeks. This completes a cycle of chemotherapy, which lasts for four weeks (28 days).
Usually 2–6 cycles of chemotherapy are given over a period of 2–4 months, depending upon how well your cancer is responding to the treatment and how well you're able to tolerate the side effects. This makes up a course of treatment.
Each person’s reaction to chemotherapy is different. The side effects described here won't affect everyone who is having vinorelbine and cisplatin chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you.
If you notice any effects that you think may be due to the drugs but aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Vinorelbine and cisplatin can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white blood cell count is called neutropenia. This begins seven days after treatment and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Feeling sick (nausea) and being sick (vomiting)
This is common and may begin soon after the treatment is given and last for a few days. Occasionally it may last longer. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Your kidneys may be affected
Cisplatin can affect your kidneys. This doesn't usually cause any symptoms and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record both what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you to pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this, so let your doctor know if this is a problem – for example, if you are feeling sick.
Bruising and bleeding
Vinorelbine and cisplatin can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Vinorelbine and cisplatin can reduce the number of red blood cells, which carry oxygen around the body.
A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre and doing some gentle exercise. You may need to take medicine (laxative) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Vinorelbine and cisplatin can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Pain along the vein used for the injection
Vinorelbine can cause pain along the vein that's used to give you your chemotherapy. If you feel any pain, tell your doctor or nurse straight away so they can check the infusion site. They may slow the infusion down to reduce pain.
Numbness or tingling in hands or feet
This is due to the effect of vinorelbine or cisplatin on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It's important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Less common side effects
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This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Changes to your hearing
Cisplatin may cause ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety and a feeling that you want to pass urine. You'll be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Leakage into the tissue (extravasation)
If this happens when vinorelbine is being given, the tissue in that area can be damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having vinorelbine and cisplatin, as they may harm the developing baby. It's important to use effective contraception while taking these drugs, and for up to a year afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our vinorelbine and cisplatin chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary.62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). (accessed October 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.