Vinca Alkaloid Toxicity

Vinca alkaloids, which belong to a class of cell cycle phase M-specific anti-tubulin agents, were one of the first plant alkaloids to be developed for use as anti-cancer agents in humans. Vinca alkaloids derived from  or the periwinkle plant () include first-generation (vincristine, vinblastine), second-generation semi-synthetic derivatives (vinorelbine, vindesine), and third-generation (vinflunine). Some have also classified vinflunine as a second-generation agent. Vinflunine is the newest vinca alkaloid and fluorinated anti-microtubule agent. The medication has been used to treat transitional cell urothelial bladder cancer. Vinflunine is reported to have a higher potency and lower frequency of adverse events when compared to the older vinca alkaloid agents. Vinca alkaloids are usually combined with other agents (as part of multi-drug combination regimens) since they potentiate the anti-cancer effects. These are also known to be well tolerated with manageable adverse events.  Examples of multidrug regimens include: CVP: cyclophosphamide, vincristine and prednisone. CHOP: cyclophosphamide, doxorubicin, vincristine and prednisone. VCRT: vinblastine, cisplatin, radiation therapy. CISCA/VB: cisplatin, doxorubicin, cyclophosphamide, vinblastine and bleomycin. ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine. Toxicity from vinca alkaloids affects multiple organ systems, including the peripheral and central nervous, cardiovascular, hematologic, renal, and pulmonary systems. Neurotoxicity is the most commonly reported adverse event.