You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search

COVID-19: Obtenez les dernières mises à jour ou faites une autoévaluation.

Effectuez un dépistage du virus de l'hépatite B chez tous les patients cancéreux débutant un traitement systémique. Apprenez-en davantage sur le dépistage et la gestion du virus de l'hépatite B.

Certaines de ces informations ou toutes, dans certains cas, n’apparaissent qu’en Anglais. Vous pouvez demander la version française

Les renseignements du Formulaire de médicaments s’adressent aux professionnels de la santé. Il ne s’agit pas d’un avis médical. Certains des renseignements, y compris ceux sur le financement des médicaments anticancéreux, ne s’appliquent pas à tous les patients. Les plans de traitement du cancer sont propres à chaque patient. Si vous êtes un patient, veuillez parler avec votre équipe soignante pour comprendre comment ces renseignements s’appliquent à vous.

A - Regimen Name

MTRXVNBL Regimen
Methotrexate-VinBLAStine


Disease Site
Sarcoma - Desmoid Tumour

Intent
Curative

Regimen Category
Evidence-Informed :

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.


Rationale and Uses

First line chemotherapy treatment for Aggressive Fibromatosis.

 
B - Drug Regimen

methotrexate
30 mg /m² IV Days 1, 8, 15 and 22
vinBLAStine
6 mg /m² IV Days 1, 8, 15 and 22
back to top
 
C - Cycle Frequency

REPEAT EVERY 28 DAYS

Until disease progression or unacceptable toxicity.

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Minimal

 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations have been adapted from clinical trials or product monographs and may be considered.

Dosage with toxicity

Hematologic Toxicities:  See Appendix 6 for general recommendations.
If severe motor neurotoxicity:     REDUCE Vinblastine to 50% dose



Hepatic Impairment

Bilirubin
% of Usual Dose
1-2.5 X ULN
REDUCE Vinblastine to 50% dose
2-3 X ULN
REDUCE Methotrexate to 50% dose
> 2.5 X ULN
REDUCE Vinblastine to 25% dose
> 3 X ULN
OMIT Methotrexate
 

Renal Impairment

Creatinine Clearance (mL/min)
% of Usual Dose *
61 to 80
REDUCE Methotrexate to 60% to 75% dose
50 to 60
REDUCE Methotrexate to 50% to 60% dose
< 50
OMIT Methotrexate
* dose reduction can be less conservative with methotrexate according to creatinine clearance in a low dose regimen.

 
F - Adverse Effects

Refer to methotrexate, vinBLAStine drug monograph(s) for additional details of adverse effects


Most Common Side Effects 

Less Common Side Effects, but may be
Severe or Life-Threatening

  • Nausea, vomiting
  • Increased LFTs
  • Abdominal pain
  • Alopecia
  • Constipation
  • Diarrhea
  • Mucositis
  • Myelosuppression +/- infection, bleeding
  • Neuropathy (may be severe)
  • Rash
  • Hypersensitivity
  • Arterial or venous thromboembolism
  • GI perforation
  • Tumour lysis syndrome
  • Pancreatitis
  • Pneumonitis
  • Nephrotoxicity
  • Leukoencephalopathy
 
G - Interactions

Refer to methotrexate, vinBLAStine drug monograph(s) for additional details

 
H - Drug Administration and Special Precautions

Refer to methotrexate, vinBLAStine drug monograph(s) for additional details

 
I - Recommended Clinical Monitoring

Recommended Clinical Monitoring


back to top
 
J - Administrative Information

Approximate Patient Visit
0.5 hour
Pharmacy Workload (average time per visit)
20.559 minutes
Nursing Workload (average time per visit)
46.667 minutes
 
K - References

Azzarelli A, Gronchi A, Bertulli R, et al. Low-dose chemotherapy with methotrexate and vinblastine for patients with advanced aggressive fibromatosis. Cancer 2001; 92: 1259-1264.

Methotrexate and vinblastine drug monographs, Cancer Care Ontario.

August 2019 Removed archived PEBC guideline link


back to top
 
L - Other Notes
Sarcomas are rare tumours and as such benefit from referral to specialized centres where there will be access to multidisciplinary expertise including good radiology, orthopedic and thoracic surgery, medical oncology, radiation oncology, pathology, and other supportive care disciplines.
 
M - Disclaimer

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.