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Chemotherapy in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Vincristine is a vinca alkaloid antimicrotubule agent derived from the periwinkle Catharanthus roseus plant. It is indicated for the treatment of choriocarcinoma, brain tumors, thyroid cancer, leukemia, lymphoma, sarcomas, and several other malignancies. As noted above, vincristine has been used in combination with bleomycin and other agents, delivering infants without abnormalities. Tewari et al. reported on the neoadjuvant treatment of cervical cancer with cisplatin and vincristine in two pregnant women, both of whom experienced significant reductions in tumor volume (19). No adverse fetal effects were noted. Bader et al. also reported on the use of cisplatin and vincristine in a patient for the neoadjuvant treatment of a cervical cancer beginning in the 23rd week of pregnancy (85). At 33 weeks, the patient then underwent a cesarean radical hysterectomy, delivering a normal infant. There have been some sporadic reports of atrial septal defects, renal hypoplasia, and pancytopenia following the use of vincristine in pregnancy (45,86,87). Several other authors have reported the successful use of vincristine, most frequently in combination with other agents, leading to the delivery and normal development of healthy infants (88,89).
Antitubulin Agents
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
All of these agents are administered by intravenous infusion, although vinorelbine can be given orally as well. The main side effects include neurotoxicity (mainly vincristine), myelosuppression (i.e., neutropenia), constipation, alopecia, mucositis, and nausea and vomiting.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Vinca alkaloids are used for the treatment of acute lymphoblastic leukaemias and for many paediatric solid tumours. The dose of vincristine is 1.5 to 2 mg/m2, without exceeding 2 mg, every 2 or 3 weeks. The dose of vindesine is 4 mg/m2 every 7 to 10 days. The dose of vinblastine is 12 mg/m2, usually by weekly administration.
Protective effect of gastrodin on peripheral neuropathy induced by anti-tumor treatment with vincristine in rat models
Published in Drug and Chemical Toxicology, 2021
Bingjie Qin, Ni Luo, Yuxing Li, Denghui Gong, Jun Zheng, Xiao Tan, Weihong Zheng
Vincristine is commonly used in treatment of breast cancer in clinic and its antitumor effects mainly rely on inhibition of tubulin polymerization, by which the formation of spindle microtubules was inhibited (Owellen et al.1976, Park et al.2010). As a result, the mitosis is arrested, and protein metabolism is interfered, which inhibits the synthesis of lipids and transporters in cellular membrane (Owellen et al.1976). Meanwhile, CIPN induced by vincristine can limit its effective dose in treatment and then obviously reduces the cure rate and the patient's life quality (Sandler et al.1969). There is so far no effective drugs or measures for prevention or treatment of CIPN (Hu et al.2017). Therefore, eliminating CIPN caused by these chemotherapeutic drugs without influencing their anti-tumor effects is of great clinical significance (Kongsgaard et al.2005).
A review of current induction strategies and emerging prognostic factors in the management of children and adolescents with acute lymphoblastic leukemia
Published in Expert Review of Hematology, 2020
Saveria Capria, Matteo Molica, Sara Mohamed, Simona Bianchi, Maria Luisa Moleti, Silvia Maria Trisolini, Sabina Chiaretti, Anna Maria Testi
Vincristine is a core chemotherapeutic agent for patients with ALL. Vincristine was first reported to be an active agent in 1962, when it was studied as a single-agent therapy in 13 patients with acute leukemia. In this study from the National Cancer Institute (NCI), 54% of patients achieved CR. In the mid-1960s, the group at SJCRH incorporated vincristine into the sequential childhood ALL protocols. Following bolus intravenous administration, peak plasma concentration is briefly achieved in children, with a rapid cellular uptake and extensive tissue binding of the drug [25]. Clearance values for children are generally greater than those for infants and adults; it is still not certain if vincristine clearance decreases with age during childhood [26]. Unfortunately, its use is associated with more than 70% of Vincristine Induced Peripheral Neuropathy (VIPN), characterized by progressive motor, sensory, and autonomic damage which impairs children’s quality of life [27,28]. This complication often leads to dose reduction, decreasing therapeutic efficacy, but it does not seem dose-related, as vincristine is usually administered at a maximum fixed dose of 2 mg regardless of body surface area.
Lurking below: massive choroidal invasion under a calcified tumor after attempted conservative therapy for retinoblastoma
Published in Ophthalmic Genetics, 2018
Kaitlin Kogachi, Jonathan W. Kim, Sarah Green, Rima Jubran, Jesse L. Berry
The previously published CHLA chemoreduction protocol (3) includes systemic chemotherapy and local consolidation therapy (diode or argon laser therapy (532 or 810 nm laser) and cryotherapy (freeze–thaw cycle ×2) for larger lesions anterior to the equator). Systemic chemoreduction includes intravenous carboplatin 780 mg/m2 (13 mg/kg for children <36 months) × 2 days, etoposide 150 mg/m2 (5 mg/kg for <36 months) × 2 days, and vincristine 1.5 mg/m2 (0.05 mg/kg for <36 months) × 1 day, for six cycles every 28 days (i.e., CEV). Infants less than 6 months of age at diagnosis receive modified doses of 50% decreases in all agents for the first cycle; subsequent doses are adjusted based on clinical response and toxicity. Vincristine is excluded for patients less than 2 months of age. All patients were clinically evaluated at routine EUA during their treatment plans with documentation of fundus findings. They were all managed with intravenous chemotherapy and local consolidation (laser consolidation, cryotherapy, intravitreal chemotherapy). If available, imaging studies included MRI, B-scan ultrasound, and OCT. Following enucleation, histopathologic reports were evaluated for high-risk pathologic findings, including post-laminar optic nerve invasion, massive choroidal invasion (>3 mm), anterior segment invasion, and scleral invasion.