Vinblastine
| Evidence Level: L4 | Predicted Indications: 10 |
Table of Contents
Vinblastine: Rhabdomyosarcoma (disease)
One-Sentence Summary
Vinblastine is a vinca alkaloid chemotherapy drug that stops cancer cells from dividing by binding to tubulin. The TxGNN model predicts it may be useful for rhabdomyosarcoma. No clinical trials are registered for this use. The supporting literature is 6 publications, only 2 of which are case reports of vinblastine-containing regimens in rhabdomyosarcoma. The evidence level is L4.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Rhabdomyosarcoma (disease) |
| TxGNN Prediction Score | 0.9986 |
| Evidence Level | L4 |
| Canada Market Status | Marketed (marketed DINs: 2 of 2) |
| Number of DINs | 2 (marketed: 2) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Vinblastine binds tubulin and blocks microtubule assembly. This arrests cells in mitosis, so it acts mainly on rapidly dividing cells. Detailed mechanism-of-action data are not available in the data compiled for this report, so this description reflects the established pharmacology of vinca alkaloids.
Rhabdomyosarcoma is a highly proliferative sarcoma, mostly seen in children, so an antimitotic drug is mechanistically plausible. Related vinca alkaloids, such as vincristine and vinorelbine, are already used in rhabdomyosarcoma protocols. Preclinical work in rhabdomyosarcoma xenografts has also examined why vinca alkaloids act selectively on tumours. Another preclinical study found that blocking PLK1 together with microtubule-destabilizing drugs kills rhabdomyosarcoma cells synergistically.
The clinical support is thin. The two case reports describe vinblastine given together with other agents, so its own contribution cannot be separated out. The high prediction score may partly reflect the general similarity of vinblastine to other drugs used in this tumour class.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 38050209 | 2023 | Case report and review | Medicine | Adult with perianal rhabdomyosarcoma and lymph node metastases. A partial response followed nivolumab, dacarbazine, cisplatin and vinblastine, and surgery came afterwards. |
| 2451411 | 1987 | Case report and review | Hinyokika Kiyo | Child with refractory prostatic rhabdomyosarcoma. The pelvic mass shrank rapidly on cisplatin, vinblastine and peplomycin, but the disease had already relapsed after standard chemotherapy. |
| 22156656 | 2011 | Pilot study | Oncotarget | Single-arm pilot of a pediatric metronomic 4-drug regimen, an indirect and low-dose approach. |
| 3329524 | 1987 | Preclinical | Anti-Cancer Drug Design | Human rhabdomyosarcoma xenografts in mice were used to study why vinca alkaloids act selectively on tumours. |
| 26024389 | 2015 | Preclinical | Cell Death & Differentiation | PLK1 inhibitors combined with microtubule-destabilizing drugs were synergistic in rhabdomyosarcoma models. |
| 14328283 | 1965 | Historical review | British Journal of Clinical Practice | General overview of tumour chemotherapy in children. |
Canada Market Information
| DIN | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 02401460 | Vinblastine Sulphate Injection | Not stated | Not stated |
| 02183056 | Vinblastine Sulfate Injection | Not stated | Not stated |
Cytotoxicity
| Item | Content |
|---|---|
| Cytotoxicity Classification | Conventional cytotoxic (vinca alkaloid, antimicrotubule agent) |
| Myelosuppression Risk | High (leukopenia and neutropenia are the main dose-limiting effects) |
| Emetogenicity Classification | Low to moderate |
| Monitoring Items | CBC with differential, liver function, renal function, and neurological assessment for peripheral neuropathy |
| Handling Protection | Must follow cytotoxic drug handling regulations. Vinca alkaloids are for intravenous use only and must never be given by other routes. |
Please refer to the package insert warnings and precautions for full details.
Safety Considerations
- Drug Interactions: 100 interactions were recorded. The strongest is a Major interaction with clarithromycin. Examples of Moderate interactions are aprepitant, dexamethasone, metronidazole, miconazole, rolapitant, rosuvastatin, simvastatin, tinidazole and troglitazone. These are relevant because many supportive-care drugs are used alongside chemotherapy.
Please refer to the package insert for warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale: The evidence level is L4. It rests on case reports where vinblastine was given within multi-drug regimens, plus preclinical studies, and no clinical trials are registered. Rhabdomyosarcoma already has established treatment protocols, and a clear role for vinblastine has not been shown.
To proceed, the following is needed:
- Review of Canadian package insert warnings, contraindications and approved indication text for the two marketed vinblastine products
- Confirmed mechanism-of-action data
- Systematic review of rhabdomyosarcoma regimens that contain vinblastine, including outcomes and toxicity
- Evidence that vinblastine adds benefit beyond the vinca alkaloids already used, for example from a prospective study or a registered trial
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.