VCR Mechanisms Indications and Toxicities

Mechanisms: VCR and vinblastine (VB) are periwinkle plant alkaloids that, like colchicine (from crocus plants) and podophyllin from mayapple plant, bind to tubulin to prevent its polymerization into microtubules, arresting mitosis at metaphase, and inhibiting cell movements and cell division.

Indicications: Leukemias, lymphomas, solid tumors.

Toxicities: CNS > bone marrow > cardiovascular:

CNS: ascending peripheral neuropathy (axo-nopathy), seizures, encephalopathy, autonomic dysfunction = paralytic ileus, atonic bladder; hypothalamic stimulation = fever and syndrome of inappropriate antidiuretic hormone secretion (SIADH) with hyponatre-mia and intravascular volume overloading. Bone marrow: Myelosuppression, VB > VCR.

Cardiovascular: Necrotic myocardial infarction as a result of alkaloid-induced coronary vasospasm and platelet aggregation.

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