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[Acute bronchospasm due to periwinkle alkaloid and mitomycin association]
P Thomas1, M Pradal, H Le Caer
1Département des maladies respiratoires, Hôpital Sainte-Marguerite, Marseille.
Revue Des Maladies Respiratoires
|January 1, 1993
Summary
Vinca alkaloids like vindesine and vinorelbine can cause acute bronchospasm in lung cancer patients receiving chemotherapy. This respiratory toxicity, especially when combined with mitomycin, necessitates careful monitoring and potential treatment cessation.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Vinca alkaloids (vindesine, vinorelbine) are used in chemotherapy for inoperable bronchial cancer, often with cisplatin and mitomycin.
- Pre-existing airflow obstruction may increase risk for respiratory side effects.
Observation:
- Six patients developed acute dyspnea within two hours of vindesine or vinorelbine injection.
- Symptoms suggested bronchospasm, occurring hours after chemotherapy, distinct from mitomycin's effects.
- One patient required respiratory support; others improved spontaneously or with bronchodilators.
Findings:
- Vinca alkaloids, particularly when combined with mitomycin, exhibit significant respiratory toxicity.
- Vinorelbine shares this toxicity profile with other vinca alkaloids like vindesine and vinblastine.
- Bronchospasm recurrence is consistent upon re-administration of vinca alkaloids, differing from mitomycin-induced pulmonary fibrosis.
Implications:
- Vinca alkaloids and mitomycin combination chemotherapy requires vigilant respiratory monitoring, including spirometry, after each vinca derivative dose.
- Discontinuation of these anti-mitotics after initial bronchospasm is advisable to prevent severe respiratory events.
- Understanding this vinca alkaloid-induced bronchospasm is crucial for managing lung cancer patients undergoing combination chemotherapy.