Vinblastine Sulfate

Hodgkin’s Disease

In combination chemotherapy as first- or second-line therapy for Hodgkin’s disease.127 135

Often used with doxorubicin, bleomycin, and dacarbazine (known as the ABVD regimen) as first-line therapy for Hodgkin’s disease.135 138

Under investigated in other combination regimens (e.g., Stanford V regimen: doxorubicin, bleomycin, vinblastine, vincristine, mechlorethamine, etoposide, and prednisone) for the treatment of advanced Hodgkin's disease.135 138

Testicular Cancer

For the treatment of advanced nonseminomatous testicular carcinoma, combination chemotherapy regimens containing vinblastine, cisplatin, and bleomycin have been used;127 128 129 130 however, most clinicians recommend regimens containing cisplatin and bleomycin, in combination with etoposide rather than vinblastine, as first-line therapy, particularly because of the reduced risk of neuromuscular toxicity and evidence suggesting greater efficacy in poor-risk patients.128 129 130 135

A regimen of cisplatin, ifosfamide, and either vinblastine or etoposide currently is considered by most clinicians to be the standard initial salvage (i.e., second-line) regimen in patients with recurrent testicular cancer.128 135

AIDS-related Kaposi’s Sarcoma

Has been used alone135 140 141 or in combination140 142 143 144 145 146 chemotherapy for the palliative treatment of AIDS-related Kaposi’s sarcoma.

Single-agent therapy with vinblastine is considered an alternative regimen.135

Combination chemotherapy with a vinca alkaloid (vinblastine or vincristine) also has been a preferred regimen,135 140 145 146 but many clinicians currently consider a liposomal anthracycline (doxorubicin or daunorubicin) the first-line therapy of choice for advanced AIDS-related Kaposi’s sarcoma.135 140 180 193 199

Combination chemotherapy with conventional antineoplastic agents (e.g., bleomycin, conventional doxorubicin, etoposide, vinblastine, vincristine) has been used for more advanced disease (e.g., extensive mucocutaneous disease, lymphedema, symptomatic visceral disease).140 145 146 182 194

A liposomal anthracycline for the treatment of advanced AIDS-related Kaposi’s sarcoma produces similar or higher response rates with a more favorable toxic effects profile than combination therapy with conventional chemotherapeutic agents.140 180 193 199

Classic Kaposi’s Sarcoma

Single-agent vinblastine has been used for the treatment of classic Kaposi's sarcoma.127 140

Bladder Cancer

In combination regimens with cisplatin and methotrexate, with or without doxorubicin, as first- or second-line therapy for invasive and advanced bladder cancer†.135 188 189 190 191

Non-small Cell Lung Cancer

In combination with cisplatin and mitomycin (MVP)126 as an alternative regimen for the treatment of non-small cell lung cancer†.135 192

Currently preferred regimens for the treatment of advanced non-small cell lung cancer include the combination of cisplatin or carboplatin, with another agent, such as paclitaxel, docetaxel, vinorelbine, or gemcitabine.135 192

Melanoma

Used in combination regimens (e.g., cisplatin, vinblastine, and dacarbazine, with or without interferon alfa and aldesleukin) for the treatment of metastatic melanoma†.135 216 218 219

Superiority of combination regimens compared with dacarbazine alone not established,212 215 217 and dacarbazine monotherapy currently is a systemic treatment of choice for metastatic melanoma.135 213 214 215 217

Brain Tumors

In combination with cisplatin and bleomycin or as monotherapy (second-line) for the treatment of intracranial germ cell tumors†.135 187

Immune Thrombocytopenic Purpura

Has been used in the treatment of immune thrombocytopenic purpura†.224

Autoimmune Hemolytic Anemia

Slow IV infusions of vinblastine106 or the use of vinblastine-loaded platelets107 108 has reportedly been effective in some cases for the treatment of autoimmune hemolytic anemia†.106 107 108

Non-Hodgkin’s Lymphoma

Palliative treatment of non-Hodgkin’s lymphomas, including lymphocytic lymphoma (nodular and diffuse, poorly and well differentiated), histiocytic lymphoma, and advanced stages of mycosis fungoides;127 however, other agents currently are preferred.135

Letterer-Siwe Disease

Treatment of Letterer-Siwe disease.127

Metabolized by CYP3A.127 185

Drugs Affecting Hepatic Microsomal Enzymes

Inhibitors of CYP3A: potential pharmacokinetic interaction (inhibition of vinblastine metabolism); earlier onset and/or increased severity of adverse effects of vinblastine may occur.127 Use concomitantly with caution.127 185

Ototoxic Drugs

Since varying degrees of permanent or temporary hearing impairment associated with eighth cranial nerve damage have been reported in patients receiving vinca alkaloids, use concomitantly with other potentially ototoxic drugs with extreme caution.127 (See Specific Drugs under Interactions.)

Specific Drugs

Absorption

Bioavailability

Unpredictably absorbed from the GI tract.b

Distribution

Extent

Following IV administration, rapidly cleared from the blood and distributed into body tissues.b Crosses the blood-brain barrier poorly and does not appear in the CSF in therapeutic concentrations.b

Elimination

Metabolism

Reported to be extensively metabolized, mainly in the liver, to desacetylvinblastine, which is more active than the parent compound on a weight basis.b 127

Mediated by CYP3A.127

Elimination Route

Excreted slowly in urine and in feces via bile.b

Special Populations

Metabolism via CYP isoenzymes may be impaired in patients with hepatic dysfunction.127