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Treatment and the treatment process

Vinca alkaloids

Vinca alkaloids are drugs originally obtained from the Madagascar periwinkle plant. The best known, vincristine, is one of the main drugs in ALL treatment.

Last updated: ~2 min read
On a dark navy background, a delicate periwinkle flower whose petals turn into a golden molecular structure.
Figure 1.Vinca alkaloids come from the periwinkle plant.

01Short answer

Vinca alkaloids — vincristine, vinblastine, vindesine and vinorelbine — block the building of the "threads" (microtubules) that pull chromosomes apart when a cell divides. As a result the cell stops in the middle of division (M phase) and dies. In leukemia, vincristine is the main one used: in ALL induction, intensification and, in some protocols, periodically during maintenance, usually as a short drip into a vein. Vincristine has little effect on the bone marrow, but its main side effect is on the nerves: numbness and tingling in the fingers, reduced reflexes, constipation, jaw pain and, rarely, a drooping eyelid or hoarse voice. If symptoms get worse, the doctor may lower the dose or pause the drug. Vincristine is given only into a vein.

02Simple explanation

From a plant. First obtained from the periwinkle.

How does it work? It breaks the "threads" of a dividing cell.

Nerves. Numb fingers and constipation can occur.

Blood. The effect on blood counts is usually mild.

03Scientific explanation

Mechanism: binds tubulin and stops microtubules from forming, so no mitotic spindle forms and the cell halts in metaphase (NCI, ACS).

Neurotoxicity: peripheral and autonomic neuropathy — tingling, loss of deep reflexes, constipation and paralytic ileus, and cranial nerve effects. Some antifungals (azoles such as itraconazole, voriconazole and posaconazole) raise vincristine levels via CYP3A4 and worsen neuropathy. Vincristine is usually avoided in Charcot–Marie–Tooth disease.

Safe administration: intrathecal vincristine can be fatal, so the WHO and other bodies recommend giving it as a drip in a mini-bag. Extravasation causes tissue damage.

04What happens in the body?

How does it work?

When a cell divides, it builds fine threads that pull the chromosomes to two sides. A vinca alkaloid prevents these threads from forming, and the cell gets stuck halfway through dividing.

In a translucent dividing cell, fine glowing threads stop halfway in teal light.
Figure 2.Vincristine stops the threads of a dividing cell.

Effects on the nerves

The fingertips and toes are most often affected. Symptoms usually ease gradually after the dose is lowered or treatment ends, but for some people they can last a long time.

Glowing nerve fibres running to the outline of a hand and foot, with small points of light at the fingertips.
Figure 3.Vincristine can cause numb fingertips.

Preventing constipation

Vincristine slows the bowel. Your team often offers preventive laxatives; plenty of fluids and moving when you can also help. Rectal medicines and suppositories are usually avoided during neutropenia.

05Treatment with vincristine

A simplified outline.

Giving — A short drip into a vein.1GivingA short drip into a vein.
Nerve check — Fingers, walking.2Nerve checkFingers, walking.
Bowels — Preventing constipation.3BowelsPreventing constipation.
Adjustment — Dose change if needed.4AdjustmentDose change if needed.
Core of ALLKey in induction.
Bone marrowLittle affected.
ReportNumbness and constipation.

06Vinca alkaloids

DrugWhereWatch for
VincristineALL, some lymphomasNeuropathy, constipation
VinblastineHodgkin lymphoma and othersBlood counts
VindesineSome protocolsNeuropathy
VinorelbineSolid tumoursBlood counts
Liposomal vincristineSome relapses, in some countriesA special form
Azole antifungalsInteractionNeuropathy may worsen

* Your doctor sets the drug and amount according to the protocol.

07Key terms

Vinca alkaloid
A drug from the periwinkle plant.
Microtubule
A thread that pulls chromosomes apart during division.
Mitotic spindle
The system of threads built during division.
Peripheral neuropathy
Nerve damage in the hands and feet.
Paralytic ileus
The bowel stopping moving.
Extravasation
The drug leaking outside the vein.

08Key points

  • Vincristine is a core drug in ALL.
  • It breaks a dividing cell’s threads.
  • Its effect on the marrow is mild.
  • It can affect the nerves.
  • Constipation should be prevented.
  • Report symptoms in good time.

09Frequently asked questions

Will the numbness go away?

It usually improves gradually; sometimes it takes months.

Why does my jaw hurt?

This is a known and usually temporary side effect of vincristine; tell your doctor.

Will my hair fall out?

Vincristine on its own usually causes only mild thinning.

Which medicines should I avoid?

Some antifungals raise its level; tell your team about every new medicine.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Will the numbness go away?

  2. Why does my jaw hurt?

  3. Will my hair fall out?

  4. Which medicines should I avoid?

My questions

12Sources

  1. National Cancer Institute (NCI). Chemotherapy to Treat Cancer
  2. American Cancer Society. How Chemotherapy Drugs Work
  3. Cancer Research UK. Chemotherapy
  4. MedlinePlus. Cancer Chemotherapy
  5. MedlinePlus. Vincristine injection
  6. National Cancer Institute (NCI). Nerve Problems (Peripheral Neuropathy) and Cancer Treatment
  7. Cancer Research UK. Treatment for chronic lymphocytic leukaemia (CLL)
  8. Cancer Research UK. Treatment for hairy cell leukaemia
  9. MedlinePlus. Hairy cell leukemia
  10. Cancer Research UK. Hairy cell leukaemia
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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