Prérequis : La venorelbine est une molécule qui est largement utilisée dans le cancer bronchique non à petite cellule, elle a montré une activité antimitotique significative.
Observation : Nous rapportons le cas d’un homme âgé de 50 ans ayant un carcinome non à petite cellule stade IV avec une métastase cérébrale. Il a bénéficié d’abord d’une radiothérapie cérébrale suivie d’une chimiothérapie à base de vinorelbine et cisplatine. Le patient a présenté une paralysie faciale unilatérale et transitoire lors de l’administration de la vinorelbine. La paralysie faciale a complètement et spontanément régressé au bout de trente minutes après la fin de l’injection. Un deuxième scanner cérébral a permis d’éliminer une éventuelle extension de la métastase cérébrale. On a noté une recrudescence de la paralysie faciale à chaque injection de la vinorelbine.
Conclusion : Nous décrivons un effet indésirable inhabituel jusque là décrit seulement chez deux patients porteur de tumeur cérébrale traités par la venorelbine.

Vinorelbine is a semi-synthetic vinca alkaloid that has demonstrated a broad spectrum of activity. It is widely used in non small cell lung cancer. Its activity in the treatment of lung carcinoma is significantly extended by incorporation into schedules utilizing cisplatin and other agents. The central nerve toxicity of vinorelbine is rarely reported.

CASE REPORT

We report the case of a 50 years old man admitted in our respiratory unit with hemoptisis. Past medical history was negative, on admission physical examination showed no abnormal signs. Peripheral blood cell count, liver and renal functions were within normal ranges. Computerizing tomography of the thorax showed consolidated shadow in the right upper lobe (fig1).

Figure 1 : Computerizing tomography of the thorax showed consolidated shadow in the right upper lobe.



In bronchoscopy, we identified a relatively large mass into the right upper lobar bronchus; biopsy confirmed the diagnosis of non small cell lung cancer. The chest computed tomography (CT) scans revealed a tumor at the right upper lobe with right mediastinal lymph nodes. Acerebral metastasis in the right-side occipital area by brain CT scans (fig2) was detected. In summary, the patient had a stage IV lung carcinoma with a unique cerebral metastasis, the treatment consisted on radiotherapy and chemotherapy based on vinorelbine and cisplatin. Focal cerebral radiotherapy was first administrated followed by intravenous chemotherapy associating vinorelbine to cisplatin. He has developed multiple subsequent and transitory episodes of monolateral left peripheral facial nerve palsy (on the opposite side to the cerebral metastasis) during vinorelbine administration. The palsy has completely and spontaneously resolved at a short interval, around twenty minutes, after the end of the drug infusion. The events were not preceded by any other symptom like headache, pain or dysaestheria. Obvious cerebral tumor progression was excluded by means of cerebral CT scan that showed partial regression; the drug was thereby administrated as scheduled until the end of the treatment and subsequent transitory episodes of facial nerve palsy reproduced at each administration.

Figure 2 : Brain CT scan showed a cerebral metastasis in the right-side occipital area.



DISCUSSION

Chemotherapy-induced cranial nerve palsies have been rarely reported. Adirect way of administering drugs toward the central nervous system is at major risk of focal neurologic complications, as hemi paresis and facial nerve palsy. The latter has been described as direct toxic effect, associated with an individual predisposing factor, which was clamed by Frustaci et al. who described in 4 patients the occurrence of cranial nerve palsy ipsilateral to the position of an intra-arterial catheter used
for the administration of cisplatin. Complete recovery was noted only in one of the patients in this report (2). Another case of demyelization of cranial nerve with subsequent palsy was also described after high-dose paclitaxel and attributed to the cumulative dose of the drug (3).
Vinorelbine is a semi synthetic vinca alkaloid that has shown anti-tumor activity against several types of cancer.
Neurotoxicity and acute pain at tumor site due to prostaglandine production are well known as side effects (4); facial nerve palsy is extremely rare.
We describe an unusual neurological side effect, until now reported in only two cases, having brain-stem gliomas, among English and French literature, dealing with vinorelbine as adjuvant treatment. The event that we observed was independent from any other sign or symptom and was not correlated to cerebral metastasis. We have considered the observed symptom as a side effect of vinorelbine as was reported in the up mentioned revue (1). The recurrences of the events when administrating the drug as well as the localization of the cerebral metastasis on the opposite side of the nerve palsy suggest highly the likelihood benign adverse effect.

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