Vincristine
| Evidence Level: L3 | Predicted Indications: 10 |
Table of Contents
Vincristine: From Acute Lymphoblastic Leukaemia and Lymphoma to Ganglioneuroblastoma
One-Sentence Summary
Vincristine is a vinca alkaloid chemotherapy drug, originally used for acute lymphoblastic leukaemia, Hodgkin and non-Hodgkin lymphoma, mantle cell lymphoma and Langerhans cell histiocytosis. The TxGNN model predicts it may be effective for Ganglioneuroblastoma. Currently there are no registered clinical trials and 6 publications (mostly case reports, plus one prospective cohort), so the evidence is limited.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Acute lymphoblastic leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma, mantle cell lymphoma, Langerhans cell histiocytosis (the Singapore licence lists no approved indication text) |
| Predicted New Indication | Ganglioneuroblastoma |
| TxGNN Prediction Score | 99.31% |
| Evidence Level | L3 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 1 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Vincristine binds tubulin and disrupts mitotic spindle formation, arresting dividing cells in metaphase. Detailed mechanism-of-action data was not available in the data compiled for this report, but this antimitotic action is well established for the vinca alkaloid class.
Ganglioneuroblastoma belongs to the same neuroblastic tumour spectrum as neuroblastoma, where vincristine is a backbone of standard chemotherapy regimens. Because both tumours are proliferative and arise from the same cell lineage, the prediction is biologically plausible. The published reports describe vincristine used inside multi-drug regimens, so its individual contribution cannot be separated out.
Other predicted indications (for context) include retroperitoneal neoplasm, nasal cavity lymphoma, ovarian lymphoma, AIDS-related primary CNS lymphoma and composite lymphoma. Most rest on indirect or combination-regimen evidence. Several others (for example, vertebral anomalies with endocrine and T-cell dysfunction, progressive transformation of germinal centres, and CLL/SLL subtypes) have no supporting studies and appear to be graph-based predictions only.
Clinical Trial Evidence
Currently no related clinical trials registered for ganglioneuroblastoma.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 31342649 | 2019 | Prospective clinical trial (cohort) | Pediatric Blood & Cancer | JN-L-10 study using image-defined risk factors to guide surgical timing in low-risk neuroblastoma; aimed to reduce treatment complications |
| 7421294 | 1980 | Case report | J Thorac Cardiovasc Surg | 31 patients with intrathoracic ganglioneuroblastoma treated by resection, radiotherapy or chemotherapy; 27 survived, up to 25 years of follow-up |
| 8255850 | 1993 | Case report | Postgrad Med J | Unresectable spinal ganglioneuroblastoma achieved histologically proven complete remission with combination chemotherapy including vincristine |
| 15701990 | 2005 | Case report | J Pediatr Hematol Oncol | Ganglioneuroblastoma presenting with obstructive jaundice, treated with cisplatin, pirarubicin/doxorubicin, cyclophosphamide and vincristine |
| 8888754 | 1996 | Case report | J Pediatr Hematol Oncol | Infant with stage 4 multifocal ganglioneuroblastoma with gastric involvement |
| 3071124 | 1988 | Case report | Hinyokika Kiyo | Adult adrenal ganglioneuroblastoma with giant regional lymph node metastasis treated with multimodality therapy |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN10319P | VINRACINE INJ. 1 mg/ml | Injection | Not stated in the available record |
Cytotoxicity
| Item | Content |
|---|---|
| Cytotoxicity Classification | Conventional cytotoxic (vinca alkaloid, antimitotic) |
| Myelosuppression Risk | Please refer to the package insert warnings and precautions |
| Emetogenicity Classification | Please refer to the package insert warnings and precautions |
| Monitoring Items | Blood counts (CBC with differential), liver function (including bilirubin), neurological assessment |
| Handling Protection | Must follow cytotoxic drug handling regulations |
Safety Considerations
- Contraindications (from knowledge-graph associations, not label text): liver failure, hyperbilirubinaemia and cholestasis (including Gilbert syndrome and familial intrahepatic cholestasis), leukopenia, peripheral neuropathy and other neuromuscular disease (including Charcot-Marie-Tooth disease, motor neuropathy and neuritis), acute urate nephropathy, and fungal, dermatophyte and other infectious disease.
- Drug Interactions: 100 interactions were identified. The one rated Major is clarithromycin. Moderate interactions include aprepitant, dexamethasone, metronidazole, eliglustat, naltrexone, glycerol phenylbutyrate, miconazole, rolapitant, rosuvastatin, simvastatin, tinidazole and troglitazone. Levofloxacin is rated Minor.
Please also refer to the package insert for full safety information, as label warnings were not available in the compiled data.
Conclusion and Next Steps
Decision: Hold
Rationale: The biological link to neuroblastic tumours is plausible and vincristine is already standard in neuroblastoma regimens. However, evidence for ganglioneuroblastoma specifically is limited to old case reports and one neuroblastoma-focused cohort, with no registered trials. Package insert safety data is also missing, which blocks safety screening.
To proceed, the following is needed:
- Singapore package insert warnings and contraindications (download and review the HSA label)
- Mechanism of action data from DrugBank
- The approved indication text for licence SIN10319P
- A focused review of neuroblastoma and ganglioneuroblastoma protocols (for example, paediatric oncology group regimens) to confirm vincristine's role in this tumour type
- Dose, neurotoxicity and hepatic-impairment guidance, given the knowledge-graph contraindications and the major clarithromycin interaction
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.