Researchers from Japan have reported that the use of nitroglycerin combined with the chemotherapy drugs Navelbine® (vinorelbine) and Platinol® (cisplatin) may improve response rates in patients with stage IIIB or stage IV non-small cell lung cancer. These results were published in the Journal of Clinical Oncology.

Lung cancer is the leading cause of cancer deaths in the U.S. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and accounts for approximately 80% of all lung cancers.

In advanced lung cancer, cancer has spread from the lung to distant sites in the body. Chemotherapy is still the cornerstone of treatment for advanced NSCLC. Long-term survival, however, remains dismal for patients with this disease. As a result, researchers continue to evaluate novel therapeutic approaches.

Researchers in Japan observed that lung cancer patients who took nitroglycerin for angina appeared to have better responses to chemotherapy than patients who did not take nitroglycerin. The explanation for a link between nitroglycerin and response to chemotherapy is uncertain; one theory is that nitroglycerin may have an effect on oxygen levels in the tumor. Low levels of oxygen in tumors are linked with resistance to some cancer treatments. Nitroglycerin may thus increase response to chemotherapy by increasing oxygenation of the tumor.

To evaluate the safety and efficacy of administering nitroglycerin along with chemotherapy for NSCLC, the researchers conducted a phase II clinical trial among 120 patients with stage IIIB or stage IV NSCLC. Half the patients received nitroglycerin along with the chemotherapy drugs Navelbine and Platinol, and half the patients received chemotherapy alone.

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The addition of nitroglycerin improved response rate and survival:

  • 72% of patients treated with nitroglycerin and chemotherapy experienced at least a partial reduction in detectable cancer, compared to 42% of patients treated with chemotherapy alone.
  • Median time until cancer progressed was 327 days in patients treated with nitroglycerin and chemotherapy, compared to 185 days in patients treated with chemotherapy alone.
  • Median survival was 413 days in patients treated with nitroglycerin and chemotherapy, compared to 289 days in patients treated with chemotherapy alone.
  • The frequency of serious adverse effects of treatment was similar in the two groups.

The researchers conclude that nitroglycerin may improve response to chemotherapy among patients with advanced NSCLC. To validate these findings, a large phase III clinical trial is underway.

Reference: Yasuda H, Yamaya M, Nakayama K et al. Randomized phase II Trial Comparing Nitroglycerin Plus Vinorelbine and Cisplatin With Vinorelbine and Cisplatin Alone in Previously Untreated Stage IIIB/IV Non-Small-Cell Lung Cancer. Journal of Clinical Oncology. 2006;24:688-694.

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