Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
VNBL
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
For the treatment of refractory Hodgkin's lymphoma
REPEAT EVERY 7 TO 14 DAYS
Until disease progression, no evidence of further response, or unacceptable toxicity.
Minimal
Other Supportive Care:
- Patients at risk of tumour lysis syndrome should have appropriate prophylaxis and be monitored closely.
Doses should be modified according to the protocol by which the patient is being treated.
Dosage with toxicity
Suggested:
|
Worst Toxicity / Counts in Previous Cycle (x 109/L)
|
Dose (% previous dose)*
|
|
Febrile neutropenia, grade 4 ANC for ≥ 5-7 days or thrombocytopenic bleeding |
|
|
Grade 3 related organ / non-hematologic
|
Hold, then 75%*
|
|
Grade 4 related organ / non-hematologic |
Discontinue
|
*Do not retreat until ANC ≥ 1-1.5 x 109L, platelets ≥ 100 x 109L and toxicity ≤ grade 2
Hepatic Impairment
| Bilirubin | % Usual dose |
| >1 - 2.5 x ULN | 50% |
| > 2.5 x ULN | 25% |
Renal Impairment
No adjustment required.
Dosage in the Elderly
Toxicity may be increased; used with caution.
Refer to vinBLAStine drug monograph(s) for additional details of adverse effects
|
More common (> 10%) |
Less Common (1-10%) |
<1% or unknown that are severe or life threatening |
|
|
|
Refer to vinBLAStine drug monograph(s) for additional details
- Avoid concomitant use with CYP3A4 inhibitors.
- Avoid concomitant use with CYP3A4 substrates if possible. Monitor closely or consider dose adjustment if they must be used together.
Refer to vinBLAStine drug monograph(s) for additional details
Administration
FOR INTRAVENOUS USE ONLY.
Intrathecal administration of other vinca alkaloids has resulted in death. Containers with this product should be labelled:
“WARNING – FOR INTRAVENOUS USE ONLY. FATAL if given intrathecally.”
- Direct IV push is not recommended to reduce the risk of inadvertently administering vinca alkaloids via intrathecal route.
- Mix in 50 mL minibag (NS or D5W).
- Dilutions in large volumes (≥ 100mL) and infusions over ≥30-60 minutes are not recommended, since these can increase the risk of vein irritation and extravasation.
- If any signs or symptoms of extravasation occur, the injection or infusion should be immediately terminated and restarted in another vein. Any known or suspected extravasation should be managed promptly according to local guidelines.
- Store unopened vials at 2 to 8ºC; protect from light.
Contraindications
- Patients who have hypersensitivity to vinblastine or its formulation
- Patients with severe myelosuppression or infection
- Intrathecal vinblastine administration is absolutely contraindicated.
Warnings/Precautions
- Myelosuppressive effects are more marked in patients with bone marrow infiltration, cachexia or skin ulcers
- Use with caution in hepatic impairment due to an increased risk of neurotoxicity.
- Use with caution in patients with ischemic heart disease and in combination with neurotoxic drugs.
- Do not give vinblastine more frequently than once every 7 days.
- Standard doses of vinblastine given for prolonged periods (e.g. daily for 7 days) may result in permanent or fatal neurologic toxicity and should not be used.
Pregnancy/lactation
- Vinblastine is contraindicated in pregnancy. Adequate contraception should be used by both sexes during vinblastine treatment and for at least 6 months after the last dose (general recommendation).
- Breast feeding is not recommended due to the potential secretion of vinblastine into breast milk.
- Effects on fertility; Aspermia and amenorrhea have been reported. Recovery of menses is variable.
Recommended Clinical Monitoring
- CBC; baseline and before each dose
- Liver function tests; baseline and as clinically indicated
- Clinical assessment for neurotoxicity, infection, bleeding, GI, local toxicity (ie. extravasation), hypersensitivity, hyperuricemia; at each visit
-
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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Kuruvilla J, Song K, Mollee P, et al. A phase II study of thalidomide and vinblastine for palliative patients with Hodgkin's lymphoma. Hematology 2006;11(1):25-9.
Little R, Wittes RE, Longo DL, et al. Vinblastine for recurrent Hodgkin's disease following autologous bone marrow transplant. J Clin Oncol 1998;16(2):584-8.
October 2020 Expanded into full regimen monograph
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.