Pain from Vinorelbine Infusion

• Pain in tumour-containing tissue (rare) as per BCCA.  
• It has been hypothesized that it is caused by a ‘‘two-step’’ pathogenetic mechanism.
• First, surgery, radiotherapy, or the tumor itself causes a neural lesion.
• Vinorelbine administration then induces production of pain modulators at the site of the lesion.
• It could be classified and treated as an incident pain.
• Patients in treatment with opioids could receive one-sixth of the daily dose 15 minutes before vinorelbine administration.
• Opioid-naïve patients could be treated with low doses of morphine. Ketorolac alone does not allow effective control of pain and we do not recommend it to treat, or to prevent, vinorelbine associated pain.
• Finally, PO administration (?compounded) does not seem to induce vinorelbine-related pain and a switch from IV to PO vinorelbine could be proposed as a method for opioid-resistant patients.