Aims and background: Vinorelbine is a new semisynthetic vinka alkaloid that has demonstrated good tolerability and interesting activity in a large spectrum of solid tumors. It was the aim of this paper to report the presence of a rarely documented side effect.
Methods: In our experience, 135 patients were treated with vinorelbine during the period 10/92 to 11/94 for a total of 1080 cycles. In 26% of the cycles, vinorelbine was administered in monochemotherapy and in 74% in polychemotherapy regimens. The dose of vinorelbine, administered in a weekly schedule, was 25 mg/m2 in 109 patients and 30 mg/m2 in 26 patients. In general, no analgesic premedication was used. Sixty-five patients had lung cancer, 45 had breast cancer, and 25 miscellaneous cancer. Only 4 patients had a previous history of neurotoxicity.
Results: Ten patients (7%) had pain in the tumor site within a few minutes of the vinorelbine injection. According to WHO grade, 5 cases had moderate and 5 severe pain. Pain was always reversible. In 5 cases ketorolac was administered after pain detection with resolution of the symptoms; in 4 cases it was necessary to deliver buprenorphine. One patient was admitted to the coronary unit because a myocardial infarction was suspected after retrosternal pain and required i.v. morphine. Seven cases refused to continue the treatment, and 3 cases had no further problem after ketorolac premedication.
Conclusions: Although rare, the presence of severe pain after vinorelbine injection may adversely affect the treatment course. Such data are helpful in the recognition and management of this reversible side effect.