Vincristine Sulfate and Myelosuppression

• Generic Name: vincristine
• Dosage Forms: n.a.
• Other Brand Names: Oncovin, Vincasar PFS

Conventional vincristine: Component of combination chemotherapeutic regimens for the induction of remissions of childhood or adult acute lymphocytic (lymphoblastic) leukemia (ALL).

Conventional vincristine: In non-high-risk childhood ALL, combination therapy with vincristine, an asparaginase preparation, and a corticosteroid (dexamethasone or prednisone) is used as an induction regimen. Intensive induction regimens with ≥4 drugs, including vincristine, an anthracycline (e.g., daunorubicin), an asparaginase preparation, and a corticosteroid, with or without cyclophosphamide, may improve event-free survival but cause greater toxicity. Some clinicians reserve 4- or 5-drug regimens for patients with high-risk childhood ALL; others elect to use such regimens for all patients with childhood ALL regardless of presenting features.

Conventional vincristine: In adults, induction regimens typically include vincristine, prednisone, and an anthracycline; some regimens also add other drugs (e.g., an asparaginase preparation, cyclophosphamide).

Liposomal vincristine: Used as a single agent for treatment of Philadelphia chromosome-negative (Ph−) relapsed or refractory ALL in patients in second or greater relapse or in those whose disease has progressed following ≥2 prior therapies (designated an orphan drug by FDA for this condition ).

Various drugs have been used for combination chemotherapy, and comparative efficacy of these regimens is continually being evaluated.

Conventional vincristine: In various combination regimens for the treatment of acute myeloid (myelogenous, nonlymphocytic) leukemias (AML, ANLL), but the comparative efficacy of these combinations is continually being evaluated.

Conventional vincristine: Component of second-line regimens for induction in AML.

Conventional vincristine: Component of various chemotherapeutic regimens for Hodgkin’s disease; comparative efficacy of various regimens is continually being evaluated.

Conventional vincristine: Used in combination with bleomycin, etoposide, doxorubicin, cyclophosphamide, procarbazine and prednisone (increased-dose BEACOPP regimen) for early or advanced Hodgkin’s disease.

Conventional vincristine: Also used in combination with doxorubicin, bleomycin, vinblastine, mechlorethamine, etoposide, and prednisone (Stanford V regimen); mechlorethamine, procarbazine, doxorubicin, bleomycin, and prednisone (MOPP-ABV regimen); and cyclophosphamide, procarbazine, doxorubicin, bleomycin, vinblastine, dacarbazine, and prednisone (COPP-ABVD regimen) for Hodgkin’s disease.

Conventional vincristine: Component of combination chemotherapeutic regimens for the treatment of non-Hodgkin’s lymphomas. Generally used with cyclophosphamide and prednisone with or without doxorubicin (i.e., CHOP or CVP regimen); rituximab usually administered with these regimens.

Comparative efficacy of various regimens is continually being evaluated, and the best combination or sequence to achieve maximum response has not been established.

Conventional vincristine: Component of various regimens for the treatment of neuroblastoma.

Conventional vincristine: Commonly used with dactinomycin, with or without cyclophosphamide, as an adjunct to surgery and/or radiation therapy.

Conventional vincristine: In children with Wilms’ tumor, generally used with dactinomycin (with or without doxorubicin) or in combination with doxorubicin, cyclophosphamide, and etoposide.

Combination chemotherapy is superior to single-drug therapy as an adjunct to surgery and/or radiation therapy in prolonging relapse-free survival and overall survival.

Conventional vincristine: Palliative treatment of various primary brain tumors.

Conventional vincristine: Various first- and second-line regimens that typically include vincristine and lomustine with another antineoplastic agent, such as procarbazine or cisplatin, or a corticosteroid (prednisone) have been used in the treatment of astrocytic tumors (e.g., glioblastoma multiforme and anaplastic astrocytoma), medulloblastoma, and oligodendroglioma.

Conventional vincristine: Used alone or in combination chemotherapy for the palliative treatment of AIDS-related Kaposi’s sarcoma.

Conventional vincristine: In combination with cyclophosphamide and doxorubicin (CAV) for the treatment of extensive-stage small cell lung cancer. Survival outcomes are similar with CAV or cisplatin/etoposide, and comparative efficacy is continually being evaluated.

Conventional vincristine: Also used in combination with cyclophosphamide and etoposide for the treatment of extensive-stage small cell lung cancer.

Current prognosis for small cell lung carcinoma is unsatisfactory regardless of stage; all patients are candidates for inclusion in clinical trials at the time of diagnosis.

Conventional vincristine: Used in combination chemotherapy for osteosarcoma (including Ewing's sarcoma), multiple myeloma, and choriocarcinoma.

Conventional vincristine: Used in combination with cyclophosphamide and prednisone (with or without doxorubicin) for chronic lymphocytic leukemia.

Conventional vincristine: Used in combination with cisplatin and fluorouracil for hepatoblastoma.

Conventional vincristine: Used in combination with cyclophosphamide and dacarbazine for pheochromocytoma.

Conventional vincristine: Has been used for treatment of immune thrombocytopenic purpura. Used IV with some success for the treatment of thrombotic thrombocytopenic purpura, and the use of vincristine-loaded platelets has reportedly been useful in some cases for the management of autoimmune hemolytic anemia.