Acute pulmonary toxicity associated with high-dose vinorelbine and mitomycin C.

Vinorelbine (VNB), 5-nor-anhydrovinblastine, is a new semisynthetic vinca alkaloid with a broad spectrum of antineoplastic activity both in vitro [1] and in vivo. Promising therapeutic results have recently been reported in different tumour types, including lung, breast, head and neck cancer, and Hodgkin's disease [2]. Data from clinical trials indicate that VNB is safe and well tolerated, with neutropenia being the most common and dose-limiting toxicity [3]. Nonhematologic adverse reactions are mostly mild or moderate, and because of the selective activity for mitotic microtubules [4], drugassociated neurotoxicity occurs less often than with other commonly used, natural vinca alkaloids. Respiratory reactions have only rarely been observed in patients treated with VNB [3]. We report here a case of acute, severe pulmonary toxicity in a patient receiving high-dose VNB and mitomycin C (MMC) for treatment of advanced breast cancer. A toxicity analysis of 87 patients treated with similar VNB dose regimens, that has been performed in view of this case, revealed a total of 16 episodes of this unusual, most likely allergic, adverse reaction.