836 J Med Assoc Thai Vol. 92 No. 6 2009 Correspondence to: Kamnerdsupaphon P, Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. The Study of Cisplatin and Vinorelbine in Metastatic Uterine Cervical Cancer Pimkhuan Kamnerdsupaphon MD*, Imjai Chitapanarux MD*, Ekkasit Tharavichitkul MD*, Vimol Sukthomya MD*, Vicharn Lorvidhaya MD* * Division of Therapeutic Radiology and Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: To determine the therapeutic efficacy of cisplatin in combination with vinorelbine in the treatment of patients with metastatic cervical cancer. Material and Method: a total of 17 patients were enrolled in the present study. The median age was 46 years (38-65). There were 6 patients who were diagnosed as stage IVB cervical cancer without previous treatment. The patients were planned to receive cisplatin 80 mg/m 2 on day 1 and vinorelbine at 30 mg/m 2 on day 1 and 8 every 3 weeks. Results: Fifteen patients were available for evaluation: 2 (13.3%) achieved a complete response, 8 (53.4%) partial responses, 3 (20%) stable diseases and 2 (13.3%) progression of the disease. Myelosuppression was the major toxicity. Grade 3-4 toxicities include 66.7% hemoglobin and 26.7% neutropenia. No other significant side effects were found. Conclusion: Cisplatin-vinorelbine is an active and well-tolerated regimen in metastatic cervical carcinoma. These results require confirmation. Keywords: Uterine cervical neoplasms, Cisplatin, Vinblastine, Vinorelbine Cervical cancer is the leading female cancer in developing countries and the second most common female malignancy worldwide (1) . It is the second major cause of death in women. Surgery and radiation therapy are effective in the majority of the cervical cancer patients. However, there remain a number of women with recurrent and/or metastatic disease, and/or with high-risk disease in early-stage, who need effective chemotherapy. Cisplatin is the most active single agent, showing a range of 21-31% response rate when used in first-line chemotherapy and approximately 10% of these responses are complete (2) . Vinca alkaloids represent a family of closely related molecules including vincristine, vindesine and vinblastine. Up to 30% response rates have been reported with vinca alkaloids in patients with minimal or no prior chemotherapy (3) , but relatively high neuro and/or hematological toxicity (4) . In addition, some clinical studies showed rather low response rates or no response (5,6) . Vinorelbine is a semi-synthetic vinca alkaloid, which differs from other vinca alkaloids by a modifica- tion of the catharanthine moiety (7) . The mechanism of action of vinorelbine is similar to that of other vinca alkaloids, i.e. disruption of microtubules by their reversible binding to tubulin, resulting in mitotic spindle dissolution and metaphase arrest in dividing cells (8) . The inhibition of tubulin polymerisation with vinorelbine is equal to or greater than that obtained with vincristine or vinblastine. Moreover, the induced spiralization is lower. Vinorelbine is equally active on mitotic microtubules and less active on axonal microtubules of the tectal plate of mouse embryos than vincristine and vinblastine. Vinorelbine was assessed in a series of phase I studies. With a weekly schedule at 35 mg/m 2 /week, the limiting toxicity was neutropenia and some neuropathies were documented. Further studies confirmed these data and permitted a dose of 30 mg/m 2 /week to be recommended for phase II J Med Assoc Thai 2009; 92 (6): 836-41 Full text. e-Journal: http://www.mat.or.th/journal