Vincristine, vinblastine, and vinorelbine are what we call vinca alkaloids. This family of chemotherapy is also natural, and it’s found in the periwinkle plant. We used these family of drugs more commonly a few years ago, or even decades ago, than we do now, but they still are incorporated in later lines. They are still upfront in a lot of lymphoma treatments. The biggest thing about this family of drugs is they cause neuropathy, but it’s not just sensory, where you have pain and numbness in your hands and feet. They can cause neuropathy of any kind. Changes in your heart rate, which is autonomic neuropathy, flushing, body temperature changes, it can even cause neuropathies of certain nerves. So if you all of a sudden aren’t able to move something right, or you notice you have double vision or central blindness… Basically it can involve any of those nerves and even cause neurotoxicity, which means that you have involvement of something in your central nervous system.
You want to be very attuned to these things because they can be subtle and potentially get worse over time with more doses. So if you notice a change in the ability of doing something like you usually do, you want to let your doctor know about that. These drugs are what we call potent vesicants, meaning if they leaked into your skin, they would cause a whole lot of damage. For that reason, they do require a line. And by that, it can be a port under your skin or what we call a peripherally inserted line that you keep for several weeks to months. This is so that it gets delivered right on top of your heart and doesn’t risk falling or leaking into your skin, which would cause serious injury. They cause GI upset, diarrhea, mucositis, which is painful lesions in your mouth and mucosal tissues, and we can do things to make those better. So you want to be aware of them and let your doctor know. They do cause hair loss and what we call SIADH, which basically is a endocrine problem that makes you have too much water. If you notice, again, neurologic symptoms, you want to let us know so we can check your sodium.