Association between Rash and a Positive Drug Response Associated with Vinorelbine in a Patient with Primary Peritoneal Carcinoma

Vinorelbine (Navelbine, VRL) is commonly used for platinum-resistant ovarian cancer and has been shown to be effective in patients with recurrent primary peritoneal carcinoma. Of VRL’s major side effects, skin rash is uncommon, and, if it does occur, it is usually localized to site of injection. In this case report, a 71-year-old Hispanic female with primary peritoneal carcinoma received single agent VRL as fourth-line regimen, which she tolerated very well except for a skin rash related to VRL. The rash continued to progress throughout 6 cycles of VRL, and follow-up CT/PET scan demonstrated complete metabolic and radiological responses. We, therefore, believe that this rash was linked to VRL administration and correlated with response to therapy. Rash has been recognized as a useful surrogate marker with targeted agents such as cetuximab and erlotinib; to the best of our knowledge, this case report describes the first patient with a possible drug rash and its association with a positive outcome. This case report incites interest in further investigation of similar cases to support this observation, since there is a lack of reports of skin rash with VRL therapy. 1. Introduction Vinorelbine (Navelbine, VRL), topotecan, and gemcitabine all have shown activity in platinum-resistant ovarian cancer [1–4]. Granulocytopenia, leukopenia, anemia, asthenia, nausea, vomiting, and constipation constitute the most common side effects associated with VRL. Although vinca alkaloids are vesicants, most dermatologic toxicities are restricted to injection sites, and unspecified rash has been rarely described with VRL [5]. In the phase II study, approximately 13% of patients demonstrated some sort of dermatologic toxicity [1]. In 3 clinical studies of patients with nonsmall cell lung cancer and advanced breast cancer, patients were treated with single agent VRL on a dosing schedule of 30？mg/m2 of VRL weekly. 28% of patients demonstrated injection site reactions, with only 2% being grade 3 [5]. Tables 1 and 2 depict the incidence of hematological versus nonhematological toxicities associated with VRL. Table 1: Summary of hematological events in 365 patients receiving single agent VRL . Table 2: Summary of nonhematological adverse events in 365 patients receiving single agent VRL . 2. Case Report A 71-year-old Hispanic female with a past medical history significant for diabetes mellitus presented to her primary care physician with a two-month history of fatigue, weight loss, early satiety, and new onset of left neck swelling. A CT scan of the neck and chest showed left-sided