Vincristine — Drug Monograph

Brand names: Oncovin, Vincasar PFS, Marqibo (liposomal)

Drug class: Vinca Alkaloid

Mechanism of Action

Binds to tubulin and inhibits polymerization of microtubules, causing mitotic arrest at the metaphase plate (M-phase specific). At higher concentrations, depolymerizes existing microtubules. Also inhibits nucleic acid and protein synthesis. Paradoxically, causes peripheral neurotoxicity by disrupting axonal transport.

FDA Indications

• Acute leukemia (ALL) — primary therapy, as part of combination regimens
• Hodgkin lymphoma (MOPP, ABVD-equivalent regimens)
• Non-Hodgkin lymphoma
• Rhabdomyosarcoma
• Neuroblastoma
• Wilms tumor
• Liposomal vincristine (Marqibo): Philadelphia chromosome-negative ALL (second or greater relapse)

Common Side Effects

• Peripheral neuropathy: dose-limiting; sensory-motor-autonomic (glove-and-stocking paresthesias, weakness, foot drop)
• Autonomic neuropathy: constipation, paralytic ileus, urinary retention, orthostatic hypotension
• Alopecia (mild to moderate)
• SIADH
• Jaw pain (after first dose — vincristine-induced pain crisis)

Clinical Pearl

Constipation from vincristine begins with the first dose — prophylactic laxatives (senna, polyethylene glycol) should be prescribed routinely. Autonomic ileus can mimic an acute abdomen. The 2 mg cap on vincristine dosing is debated — some data suggest tall patients (BSA >2 m²) are underdosed and this may reduce efficacy in ALL.

Related Therapies & Mechanisms

• Acalabrutinib (Calquence) — Lymphoma
• Bendamustine (Treanda) — Lymphoma
• Brexucabtagene autoleucel (Tecartus) — Lymphoma
• Cyclophosphamide (Cytoxan) — Lymphoma