Vinblastine
| Evidence Level: L4 | Predicted Indications: 10 |
Table of Contents
Vinblastine: From Hodgkin Lymphoma and Other Lymphomas to Rhabdomyosarcoma
One-Sentence Summary
Vinblastine is a vinca alkaloid chemotherapy drug originally used for lymphomas (including Hodgkin lymphoma, non-Hodgkin lymphoma and mycosis fungoides) and Langerhans cell histiocytosis. The TxGNN model predicts it may be effective for rhabdomyosarcoma. Currently there are 0 registered clinical trials and 7 publications (case reports, a small pilot study and preclinical work) for this direction, so the evidence is limited.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Mycosis fungoides, primary cutaneous T-cell lymphoma, Hodgkin lymphoma, non-Hodgkin lymphoma, mantle cell lymphoma, Langerhans cell histiocytosis (from the knowledge graph; the Singapore licence records carry no indication text) |
| Predicted New Indication | Rhabdomyosarcoma |
| TxGNN Prediction Score | 99.86% |
| Evidence Level | L4 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 2 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Vinblastine is a vinca alkaloid. It binds tubulin and disrupts microtubule assembly, which causes cells to arrest in mitosis. Detailed mechanism-of-action data were not available in the data compiled for this report, so this description reflects the known pharmacology of the drug class.
Rhabdomyosarcoma is a rapidly proliferating soft tissue sarcoma, so an antimitotic agent is biologically plausible. A related vinca alkaloid, vincristine, is already a standard part of rhabdomyosarcoma regimens (such as VAC). This gives class-level support, but it is not direct evidence for vinblastine itself.
The evidence specific to vinblastine is thin. It consists of case-level reports in which vinblastine was given within multi-drug regimens, so its individual contribution cannot be separated out. There is also preclinical work showing that microtubule-destabilising drugs act synergistically with PLK1 inhibitors in rhabdomyosarcoma models.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 38050209 | 2023 | Case report/Review | Medicine | Adult perineal rhabdomyosarcoma; partial response after nivolumab, dacarbazine, cisplatin and vinblastine, followed by surgery |
| 2451411 | 1987 | Case report/Review | Hinyokika Kiyo | Refractory prostatic rhabdomyosarcoma in a child; the pelvic mass shrank rapidly with cisplatin, vinblastine and peplomycin |
| 2417460 | 1985 | Case report | Hinyokika Kiyo | Prostatic rhabdomyosarcoma in a child treated with cisplatin, vinblastine and bleomycin |
| 22156656 | 2011 | Pilot study | Oncotarget | Pilot of a pediatric metronomic 4-drug regimen |
| 3329524 | 1987 | Preclinical | Anti-Cancer Drug Design | Therapeutic selectivity of vinca alkaloids examined in rhabdomyosarcoma xenografts in mice |
| 26024389 | 2015 | Preclinical | Cell Death & Differentiation | PLK1 inhibitors and microtubule-destabilising drugs are synthetically lethal in rhabdomyosarcoma models |
| 41216926 | 2026 | Cohort | Pediatric Blood & Cancer | CWS-96 and CWS-2002P trials in non-rhabdomyosarcoma soft tissue sarcoma (indirect) |
Related predicted sub-types (prostate embryonal rhabdomyosarcoma, rank 5) rely on the same two 1980s case reports. Other predicted sub-types (vaginal botryoid, parameningeal, bile duct) and ganglioneuroblastoma have no trials or literature. Liver sarcoma, monocytic leukaemia and neuroblastoma have only indirect, historical or preclinical evidence.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN07944P | DBL™ Vinblastine Injection | Injection | Indication text not available |
| SIN10987P | Velbastine for Injection 10 mg/vial | Injection, powder, for solution | Indication text not available |
Cytotoxicity
| Item | Content |
|---|---|
| Cytotoxicity Classification | Conventional cytotoxic (vinca alkaloid, antimitotic) |
| Myelosuppression Risk | High (leukopenia/neutropenia is the dose-limiting effect; the knowledge graph also flags neutropenia, thrombocytopenia and agranulocytosis) |
| Emetogenicity Classification | Low to moderate |
| Monitoring Items | CBC with differential, liver function (bilirubin), peripheral neurological assessment |
| Handling Protection | Must follow cytotoxic drug handling regulations; injectable for intravenous use only |
Please refer to the package insert warnings and precautions for formal guidance.
Safety Considerations
- Contraindication signals (knowledge graph, not label text): Conditions linked to the drug include neutropenia, thrombocytopenia, agranulocytosis, liver failure, hyperbilirubinemia (including Gilbert syndrome), peripheral neuropathy and peripheral nervous system disease, lung disease, myocardial ischemia and coronary artery disease, and infectious disease (including fungal infection and dermatophytosis). These should be verified against the official package insert.
- Drug Interactions: 100 interactions were found. Notable ones:
- Major: Clarithromycin
- Moderate: Aprepitant, Rolapitant, Dexamethasone, Metronidazole, Tinidazole, Miconazole, Eliglustat, Rosuvastatin, Simvastatin, Glycerol phenylbutyrate, Troglitazone
- Minor: Levofloxacin
- Several others (for example pantoprazole, omeprazole, prednisone, ondansetron) have an unrated interaction level.
- Literature safety signal: One report describes severe ileus with a cisplatin-vinblastine infusion in neuroblastoma.
Package insert warnings and label contraindications were not available in the data compiled for this report. Please refer to the package insert for safety information.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction score is high, and the antimitotic mechanism is plausible. However, there are no registered trials. The only vinblastine-specific clinical evidence is a few case reports, with vinblastine given within multi-drug regimens. Vincristine, not vinblastine, is the established vinca alkaloid in rhabdomyosarcoma.
To proceed, the following is needed:
- Singapore package insert warnings and contraindications (currently a blocking gap for safety screening)
- Detailed mechanism of action data from DrugBank
- A systematic review of vinblastine-containing regimens in rhabdomyosarcoma, compared with the vincristine-based standard
- Evidence for the indication text of the Singapore licences
- Other predicted indications are weaker or more indirect: monocytic leukaemia has the most clinical data, but it is old, small and no longer reflects standard care, and the remaining predictions rest on the model score alone.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.