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Non small cell lung cancer metastatic vinORELBine (oral)

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Cycle 1 and further cycles

Drug Dose Route Day
vinORELBine 60 mg/m2 ONCE a week * PO 1

*If tolerated, consider increasing the dose to 80 mg/m2 ONCE a week from week 4 (see dose escalation below). Dosing may require rounding to the nearest capsule strength to enable delivery of a measurable dose.

Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
Notes:

The survival benefit has only been demonstrated over placebo in the first line setting when used as a monotherapy. Good performance status and younger patients should be considered for platinum based combination therapy.

Bioequivalence: 60 mg/m2 of oral vinorelbine is equivalent to 25 mg/m2 of intravenous vinorelbine and 80 mg/m2 of oral vinorelbine is equivalent to 30 mg/m2 of intravenous vinorelbine.

When treating on a BSA above 2 a total dose of 120 mg should not be exceeded if treating at 60 mg/m2 or 160 mg if treating at 80 mg/m2 (BSA is capped at 2).

NB: Two major differences are associated with the oral administration: a higher inter-subject variability reflecting significant differences in the absorption rate from one patient to another and a higher incidence of gastrointestinal side-effects. Oral administration seems to increase the incidence, but not the severity, of nausea, vomiting and diarrhoea. Prior administration of anti-emetics is recommended.

Drug status:

Vinorelbine (PBS authority opens in a new tab or window)

Cost:
~ $280 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1 and further cycles

Day 1
Granisetron 2 mg (PO) 60 minutes before chemotherapy
vinORELBine 60 mg/m2 (PO) ONCE a week with food. If tolerated, consider increasing the dose from week 4 (see dose escalation in dose modifications section).*

* Dosing may require rounding to the nearest capsule strength to enable delivery of a measurable dose.

Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity

Cycle 1 and further cycles

Drug Dose Route Day
vinORELBine 60 mg/m2 ONCE a week * PO 1

*If tolerated, consider increasing the dose to 80 mg/m2 ONCE a week from week 4 (see dose escalation below). Dosing may require rounding to the nearest capsule strength to enable delivery of a measurable dose.

Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
Notes:

The survival benefit has only been demonstrated over placebo in the first line setting when used as a monotherapy. Good performance status and younger patients should be considered for platinum based combination therapy.

Bioequivalence: 60 mg/m2 of oral vinorelbine is equivalent to 25 mg/m2 of intravenous vinorelbine and 80 mg/m2 of oral vinorelbine is equivalent to 30 mg/m2 of intravenous vinorelbine.

When treating on a BSA above 2 a total dose of 120 mg should not be exceeded if treating at 60 mg/m2 or 160 mg if treating at 80 mg/m2 (BSA is capped at 2).

NB: Two major differences are associated with the oral administration: a higher inter-subject variability reflecting significant differences in the absorption rate from one patient to another and a higher incidence of gastrointestinal side-effects. Oral administration seems to increase the incidence, but not the severity, of nausea, vomiting and diarrhoea. Prior administration of anti-emetics is recommended.

Drug status:

Vinorelbine (PBS authority opens in a new tab or window)

Cost:
~ $280 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1 and further cycles

Day 1
Granisetron 2 mg (PO) 60 minutes before chemotherapy
vinORELBine 60 mg/m2 (PO) ONCE a week with food. If tolerated, consider increasing the dose from week 4 (see dose escalation in dose modifications section).*

* Dosing may require rounding to the nearest capsule strength to enable delivery of a measurable dose.

Frequency:
7 days 
Cycles:
Continuous until disease progression or unacceptable toxicity
  • Locally advanced, recurrent or metastatic non small cell lung cancer
    • for consideration in elderly patients but use caution as myelosuppression is a major side effect with this treatment.
Caution with oral anti-cancer drugs

Select links for information on the safe prescribing, dispensing and administration of orally administered anti-cancer drugs. 

Read more about at COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy opens in a new tab or window and oral anti-cancer therapy opens in a new tab or window
Emetogenicity moderate to high

Although this treatment is classified as having moderate to high emetogenicity, routine antiemetic premedication may not be required. Consider prophylaxis with a 5HT3 receptor antagonist e.g. granisetron 2 mg PO daily and re-assess routinely.

Read more about preventing anti-cancer therapy induced nausea and vomiting
Constipation

Prescribe prophylactic laxatives to prevent constipation related to the use of vinca alkaloids.
Peripheral neuropathy

Assess prior to each treatment. If a patient experiences grade 2 or greater peripheral neuropathy, a dose reduction, delay, or omission of treatment may be required; review by medical officer before commencing treatment.

Read more about peripheral neuropathy

Link to Anti-cancer drug induced peripheral neuropathy screening tool
Pulmonary toxicity

There have been infrequent reports (less than 5% of patients) of pulmonary toxicity associated with vinorelbine.

Read more about pulmonary toxicity associated with anti-cancer drugs.
Blood tests

FBC, EUC, eGFR and LFTs at baseline and prior to each treatment.
Hepatitis B screening and prophylaxis

Routine screening for HBsAg and anti-HBc is NOT usually recommended for patients receiving this treatment.

Read more about hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy
Vaccinations

Live vaccines are contraindicated in cancer patients receiving immunosuppressive therapy and/or who have poorly controlled malignant disease. Possible suboptimal response to inactivated vaccines.

For more information about vaccinations in people with cancer refer to the Australian Immunisation Handbook opens in a new tab or window.
Fertility, pregnancy and lactation

Cancer treatment can have harmful effects on fertility and this should be discussed with all patients of reproductive potential prior to commencing treatment. There is a risk of fetal harm in pregnant women. A pregnancy test should be considered prior to initiating treatment in females of reproductive potential if sexually active. It is important that all patients of reproductive potential use effective contraception whilst on therapy and after treatment finishes. Effective contraception methods and adequate contraception timeframe should be discussed with all patients of reproductive potential. Possibility of infant risk should be discussed with breastfeeding patients.

Read more about the impact of cancer treatment on fertility opens in a new tab or window
Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient’s situation including but not limited to treatment intent (curative vs palliative), the anti-cancer regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient preferences.Suggested dose modifications are based on clinical trial findings, product information, published guidelines and reference committee consensus . The dose reduction applies to each individual dose and not to the total number of days or duration of treatment cycle unless stated otherwise. Non-haematological gradings are based on Common Terminology Criteria for Adverse Events (CTCAE) opens in a new tab or window unless otherwise specified. Renal and hepatic dose modifications have been standardised where possible. For more information see dosing considerations & disclaimer.

Note: All dose reductions are calculated as a percentage of the starting dose.

Dose escalation
For consideration only in the absence of significant myelosuppression

Increase the dose to 80 mg/m2 weekly, on week 4 if tolerated
Note: the dose should not be increased to 80 mg/m2 in patients whose absolute neutrophil count has dropped once to less than 0.5 x 109/L, or more than once between 0.5 to 1.0 x 109/L.

When treating on a BSA greater than 2, a total dose of 120 mg should not be exceeded if treating at 60 mg/m2 or 160 mg if treating at 80 mg/m2
Haematological toxicity
ANC x 109/L (pre-treatment blood test)
1.0 to less than 1.5 Refer to local institutional guidelines; it is the view of the expert clinicians that treatment should continue if patient is clinically well
0.5 to less than 1.0 Delay treatment until recovery
less than 0.5 Delay treatment until recovery and reduce vinorelbine by 25% for subsequent cycles
Febrile neutropenia or previous delay for myelosuppression Delay treatment until recovery and reduce vinorelbine by 25% for subsequent cycles
Prolonged recovery greater than two weeks delay or 3rd delay for myelosuppression Delay treatment until recovery and reduce vinorelbine by 50% for subsequent cycles or cease
Platelets x 109/L (pre-treatment blood test)
75 to less than 100 The general recommendation is to delay, however if the patient is clinically well it may be appropriate to continue treatment; refer to treating team and/or local institutional guidelines
50 to less than 75 Delay treatment until recovery
less than 50 Delay treatment until recovery and reduce vinorelbine by 25% for subsequent cycles
Kidney dosing recommendations 
  • Suggested dose modifications are based on the International Consensus Guideline on Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD).
  • Where one or more drugs in a protocol is recommended to be avoided, consider using a clinically appropriate alternative treatment protocol instead.
  • Before dose adjusting or omitting a drug, consider treatment intent.
  • In kidney replacement therapy consult a multidisciplinary team consisting of oncology/haematology with nephrology and/or clinical pharmacology for the management of dosing. 
  • For complete information on individual drug recommendations please review the individual drug monograph in the ADDIKD guideline.
eGFR
(mL/min/1.73m2)		 Vinorelbine
≥ 60

Full dose
45 - 59

Full dose
30 - 44

Full dose
15 - 29

Full dose
< 15
(without kidney replacement therapy)		 Full dose
Hepatic impairment
Hepatic dysfunction
Mild Reduce vinorelbine by 25%
Moderate Reduce vinorelbine by 50%
Severe Omit vinorelbine
Peripheral neuropathy
Grade 2 which is present at the start of the next cycle Reduce vinorelbine by 25%; if persistent, reduce vinorelbine by 50%
Grade 3 or Grade 4 Omit vinorelbine

The drug interactions shown below are not an exhaustive list. For a more comprehensive list and for detailed information on specific drug interactions and clinical management, please refer to the specific drug product information and the following key resources: 

For more information see References & Disclaimer.

Vinorelbine
  Interaction Clinical management
CYP3A4 and P-gp inhibitors (e.g. amiodarone, aprepitant, azole-antifungals, ritonavir, lapatinib, nilotinib, sorafenib, macrolides, ciclosporin, grapefruit juice etc.) Increased toxicity of vinorelbine possible due to reduced clearance Monitor for vinorelbine toxicity (esp. neurotoxicity, myelosuppression)
CYP3A4 inducers (e.g. carbamazepine, phenytoin, phenobarbitone, rifampicin, St John's wort etc.) Reduced efficacy of vinorelbine possible due to increased clearance Monitor for decreased clinical response to vinorelbine
Mitomycin Increased risk of pulmonary toxicity when vinorelbine administered following or concomitantly with mitomycin Avoid combination or monitor closely for pulmonary toxicity (i.e. interstitial infiltrates, pleural effusion resulting in respiratory distress and cough)
General
  Interaction Clinical management
Warfarin Anti-cancer drugs may alter the anticoagulant effect of warfarin. Monitor INR regularly and adjust warfarin dosage as appropriate; consider alternative anticoagulant.
Direct oral anticoagulants (DOACs) e.g. apixaban, rivaroxaban, dabigatran

Interaction with both CYP3A4 and P-gp inhibitors /inducers.

DOAC and anti-cancer drug levels may both be altered, possibly leading to loss of efficacy or toxicity (i.e. increased bleeding).

Apixaban: avoid concurrent use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window inhibitors. If treating VTE, avoid use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window inducers. 

Rivaroxaban: avoid concurrent use with strong CYP3A4 opens in a new tab or window and P‑gp opens in a new tab or window  inhibitors.

Dabigatran: avoid combination with strong P‑gp opens in a new tab or window inducers and inhibitors.

If concurrent use is unavoidable, monitor closely for efficacy/toxicity of both drugs.
Digoxin Anti-cancer drugs can damage the lining of the intestine; affecting the absorption of digoxin. Monitor digoxin serum levels; adjust digoxin dosage as appropriate.
Antiepileptics Both altered antiepileptic and anti-cancer drug levels may occur, possibly leading to loss of efficacy or toxicity. Where concurrent use of an enzyme-inducing antiepileptic cannot be avoided, monitor antiepileptic serum levels for toxicity, as well as seizure frequency for efficacy; adjust dosage as appropriate.
Also monitor closely for efficacy of the anti-cancer therapy.
Antiplatelet agents and NSAIDs Increased risk of bleeding due to treatment related thrombocytopenia. Avoid or minimise combination.
If combination deemed essential, (e.g. low dose aspirin for ischaemic heart disease) monitor for signs of bleeding.
Serotonergic drugs, including selective serotonin reuptake inhibitors (SSRIs e.g. paroxetine) and serotonin noradrenaline reuptake inhibitors (SNRIs e.g. venlafaxine) Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.) Avoid combination.
If combination is clinically warranted, monitor for signs and symptoms of serotonin syndrome (e.g. confusion, agitation, tachycardia, hyperreflexia).
For more information link to TGA Medicines Safety Update opens in a new tab or window

eviQ provides safe and effective instructions on how to administer cancer treatments. However, eviQ does not provide every treatment delivery option, and is unable to provide a comprehensive list of cancer treatment agents and their required IV line giving set/filter or address chemical compatibilities related to IV drug preparation and administration. There may be alternative methods of treatment administration, and alternative supportive treatments that are also appropriate. Please refer to the individual product information monographs via the TGA opens in a new tab or window and Australian Injectable Drugs Handbook opens in a new tab or window websites for further information.

eviQ is currently updating the way information is presented in the administration section, if you notice any discrepancies please let us know, via feedback@eviq.org.au.

Day 1

This is an oral treatment

Any toxicity grade 2 or greater may require dose reduction, delay or omission of treatment and review by medical officer before commencing treatment.

Anti-cancer drug patient assessment tool prior to each day of treatment.

Anti-cancer drug induced neuropathy screening tool prior to each treatment.

Pre treatment medication

Verify antiemetics taken or administer as prescribed.

Vinorelbine

  • administer orally ONCE weekly
  • to be swallowed whole with a glass of water; do not break, crush or chew
  • to be taken at the same time every week with food
  • food does not affect absorption but it is advised patients take with a light snack to reduce G.I upset
  • if the patient chews or sucks the capsule by mistake, they should rinse their mouth out with water or preferably sodium chloride 0.9%

Note: if a capsule is forgotten or vomited, consult treating team

Continue safe handling precautions until 7 days after completion of drug(s).

Discharge information

Vinorelbine capsules - with written instructions on how to take them.

Antiemetics - as/if prescribed.

Laxatives - ensure patient has prophylactic laxatives.

Patient information

Ensure patient receives protocol patient information sheet.

The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.

Immediate (onset hours to days)
Nausea and vomiting

Read more about prevention of treatment induced nausea and vomiting

Early (onset days to weeks)
Neutropenia

Abnormally low levels of neutrophils in the blood. This increases the risk of infection. Any fever or suspicion of infection should be investigated immediately and managed aggressively. 

Read more about immediate management of neutropenic fever
Fatigue

Read more about fatigue
Oral mucositis and stomatitis

Erythematous and ulcerative lesions of the gastrointestinal tract (GIT). It commonly develops following anti-cancer treatment, radiation therapy to the head, neck or oesophagus, and high-dose chemotherapy followed by a blood and marrow transplant (BMT).

Read more about oral mucositis and stomatitis
Diarrhoea

Read more about treatment induced diarrhoea
Constipation
Arthralgia and myalgia

Generalised joint pain or and/or stiffness and muscle aches, often worse upon waking or after long periods of inactivity. Can improve with movement. May be mild or severe, intermittent or constant and accompanied by inflammation. 

Read more about arthralgia and myalgia
Peripheral neuropathy

Typically symmetrical sensory neuropathy, affecting the fingers and toes, sometimes progressing to the hands and feet.  It is associated with several classes of anti-cancer drugs. These include taxanes, platinum-based compounds, vinca alkaloids and some drugs used to treat multiple myeloma.

Read more about peripheral neuropathy

Late (onset weeks to months)
Anaemia

Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. 

Read more about anaemia
Alopecia - partial

Hair thinning and/or patchy hair loss. Patients can also experience mild to moderate discomfort of the hair follicles, and rarely pain as the hair is falling out.

Read more about alopecia and scalp cooling
Pulmonary toxicity

Pulmonary toxicity may include damage to the lungs, airways, pleura and pulmonary circulation. 

Read more about pulmonary toxicity associated with anti-cancer drugs

eviQ is currently updating the way information is presented in the evidence section to improve usability, consistency and facilitate easier update and maintenance. An updated evidence template is being implemented in a staged approach, first across new protocols, then existing protocols as they are reviewed. Find out more

The feasibility and safety profile of oral vinorelbine was shown in 4 phase II studies with 138 patients (76 with NSCLC and 62 with advanced breast cancer) by Depierre et al 2001. For the first line treatment of patients with NSCLC, study CA 205r showed oral vinorelbine was no worse than IV vinorelbine in terms of effectiveness.

An example, of use as first line treatment in an elderly NSCLC population is shown in a phase III randomised trial by Gridelli et al. 698 patients randomised to either vinorelbine IV (233 patients), Gemcitabine (233 patients) or vinorelbine plus gemcitabine (232 patients). Single agent vinorelbine was shown to prolong survival and quality of life in elderly patients.r

Efficacy

Oral vinorelbine as a substitute for IV vinorelbine when used as monotherapyr

Jassem et alr​

Oral vinorelbine n=77 (%)

IV vinorelbine n=38 (%)
Partial response
Intent To Treat (ITT)		 12 (95%CI 5-19) 11 ( 95% CI 1-20)
Partial response
Evaluable patients		 14 (95%CI 6-23)  12(95%CI 1-23) 
Stable disease(ITT) 38 45
 Not evaluable 10 8

Vinorelbine versus placebo

The effect of vinorelbine was compared to supportive care in the Elderly Lung Cancer Vinorelbine Italian Study Group and vinorelbine was shown to improve survival in elderly patients with advanced NSCLC and possibly improve overall QOL.

The control arm in this study was supportive care aloner

Survival:r

© J Natl Cancer Inst 1999

Toxicity

Neutropenia was the major toxicity and grade 3 or 4 was noted in 42% of patients commenced at 80 mg/m2 which led to the recommendation that dose should begin at 60 mg/m2 and be escalated only in absence of toxicity. One death was reported from septic shock in the NSCLC group, and one death from paralytic ileus associated with dehydration and electrolyte disorders.

In comparison to iv vinorelbine early studies have shown a higher rate of nausea, vomiting and diarrhoea with oral vinorelbine. Later studies, Gridelli et al.r showed that the incidence of GIT toxicity was reduced by the routine use of 5HT3 antagonist medications and by taking oral vinorelbine with food.

Adverse eventr  Oral vinorelbine
n=76  all grades (%)		  IV vinorelbine
n=38  all grades (%)
Leucopenia 59 84
Neutropenia 62 86
Anaemia 84 84
Thrombocytopenia 7 14
Nausea 79 43
Vomiting 62 19
Diarrhoea 39 14
Stomatis 8 14
Neurological toxicity(All) 63 40
Neuroconstipation 7 24
Drug related fatal outcomes 3 2
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Version 6

Date Summary of changes
08/02/2024
  • Protocol updated with ADDIKD guideline recommendations. New kidney dosing recommendation table added to dose modification section. PDF of previous protocol.
  • Protocol assessed by eviQ medical oncology reference committee and deemed suitable to be reviewed as required. Flag added, review date removed and version number increased to V.6. Read more about as required review protocol status in this factsheet.

Version 5

Date Summary of changes
12/09/2023 Dexamethasone removed from the detailed treatment schedule to align with ID 7 Prevention of anti-cancer therapy induced nausea and vomiting.

Version 4

Date Summary of changes
12/09/2009 Reviewed and transferred to eviQ.
02/07/2010 Haematological dose modifications updated ( 20% changed to 25% dose reduction).
19/10/2010 Dose modifications updated: "consider reducing" changed to " reduce".
19/11/2011 New format to allow for export of protocol information.
Protocol version number changed to V.2.
Antiemetics and premedications added to the treatment schedule.
Additional Clinical Information, Key Prescribing table and Key Administration table combined into new section titled Clinical Considerations.
Drug specific information placed behind the drug name link.
30/11/2012

Protocol reviewed at Medical Oncology Reference Committee meeting. CPG link added.
No change and next review in 2 years.
02/09/2014 PHC view removed.
12/09/2014 Protocol reviewed at Medical Oncology Reference Committee meeting. No change. Next review in 2 years.
18/02/2016 Discussed with Medical Oncology Reference Committee Chairs, for review every 5 years. Next review 3 years.
31/05/2017

Transferred to new eviQ website. Version number change to V.3.

Hepatitis B screening changed to NOT recommended.
10/05/2018 Haematological dose modifications updated as per consensus of the expert clinician group. Version number changed to V.4. 
22/06/2018

Antiemetics updated to be in line with international guidelines. Note to dexamethasone added.
02/04/2020 Protocol reviewed electronically by Medical Oncology Reference Committee. No changes. Review 4 years.
21/06/2021 Changed antiemetic clinical information block to moderate to high, to align with new categories. See ID 7 Prevention of anti-cancer therapy induced nausea and vomiting (AINV) v5.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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First approved:
Last reviewed:
Review due:
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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/309

29 Jun 2025