This information is about a chemotherapy treatment for non-small cell lung cancer using vinorelbine and carboplatin. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

The treatment involves the two chemotherapy drugs vinorelbine, which is also known as Navelbine®, and carboplatin.

Vinorelbine and carboplatin chemotherapy treatment can usually be given to you as a day patient. You will need to have a blood test before you start treatment – either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

The nurse will then put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy through a thin plastic tube which is inserted under the skin and into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.

You will be given some anti-sickness (anti-emetic) medicines. These are usually given by injection (through the cannula, central or PICC line) which is connected to a drip (infusion). 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 slow injection, that takes about 6-10 minutes, along with a drip of salt water (saline) into your cannula. Vinorelbine is also available as capsules.
• Carboplatin (a colourless fluid) is given as a drip which takes between 30 minutes and an hour.

If you are a day patient you can go home after your treatment. The cannula will be removed and you will be given a supply of anti-sickness medicines to take with you. It is important to take these as directed even if you are not feeling sick. This is because some anti-sickness medication is better at preventing sickness than at stopping it once it has started.

Your doctor may use the word 'regimen' (eg the vinorelbine carboplatin regimen) when talking about your chemotherapy. This means the whole plan or schedule of the chemotherapy treatment that you are being given.

On the first day of your treatment (day 1) you will be given both the vinorelbine and the carboplatin as described above. One week later (day 8) you will be given another dose of vinorelbine. After this you will have a rest with no chemotherapy for two weeks. This completes what is called a cycle of treatment.

You start the next cycle of your treatment after the rest period, which is three weeks after your first injection. Usually six cycles are given over a period of four months. This makes up a course of treatment.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is having vinorelbine and carboplatin chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed here, please let your nurse or doctor know.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness medicines which may be more effective. Some anti-sickness medicines may cause constipation. Let your doctor or nurse know if this is a problem.

Lowered resistance to infection Vinorelbine and carboplatin chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually return to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding Vinorelbine and carboplatin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with these drugs you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these effects are a problem.

Your kidney function may be affected Usually this does not 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 you will have a blood test to check how well your kidneys are working. You may be asked to drink more than normal on the day after treatment.

It is important to tell your doctor or chemotherapy nurse if you are not able to drink enough. You should also let them know if you are not passing as much urine as normal.

Constipation Constipation may occur and can usually be relieved by drinking plenty of fluids, eating a high-fibre diet and taking gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.

Diarrhoea This can usually be controlled easily with medicines but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you do have diarrhoea. If you have any change in bowel habit, tell your doctor.

Pain along the vein used for the injection Vinorelbine can cause irritation at the site used for the injection. If this happens it is important to tell the person giving the drug, as they can reduce the problem by flushing the drug through with more fluid or use capsules instead.

Numbness or tingling in hands or feet This is due to the effect of vinorelbine and carboplatin on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. The problem usually improves slowly a few months after treatment is over.

Hair loss This is rare but your hair may thin, or occasionally be lost completely. If this happens it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. Hair loss is temporary and your hair will start to grow again once treatment has finished.

Temporary taste alterations and loss of appetite You may notice that your food tastes different. Normal taste will come back after the treatment finishes. A dietitian or specialist nurse at your hospital can give advice on boosting your appetite, coping with eating difficulties and maintaining weight.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness or darkening of the face, dizziness, a headache, breathlessness, anxiety and a need to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having 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 is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information. 

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Always tell your doctor about any medicine you are taking. This includes any that you may have bought from a pharmacy or supermarket, as well as any herbal or complementary therapies.

Leakage into the tissue around the vein If vinorelbine leaks into the tissue around the vein this can damage the cells in that area. If you notice any stinging or burning around the vein while either drug is being given, tell the doctor or nurse immediately.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking this treatment as it may harm the developing foetus. It is important to use effective contraception whilst taking this drug, and for up to a year afterwards. Again, discuss this with your doctor.

This section is based upon our vinorelbine and carboplatin chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry, M. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.