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Uses

As a component of many chemotherapeutic regimens because of its relative lack of hematologic toxicity.

Acute Lymphocytic Leukemia

Component of combination chemotherapeutic regimens for the induction of remissions of childhood or adult acute lymphocytic (lymphoblastic) leukemia (ALL).

First-line therapy in combination with other drugs (e.g., prednisone, daunorubicin or doxorubicin, with or without asparaginase, with or without cytarabine) for induction of ALL.

Also a component of second-line regimens (e.g., high-dose methotrexate, with or without cytarabine) for induction of ALL.

Various drugs have been used for combination chemotherapy, and comparative efficacy of these regimens is continually being evaluated.

Acute Myeloid Leukemia

In various combination regimens for the treatment of acute myeloid (myelogenous, nonlymphocytic) leukemias (AML, ANLL), but the comparative efficacy of these combinations is continually being evaluated.

Component of second-line regimens for induction in AML.

Hodgkin’s Disease

Component of various chemotherapeutic regimens as second-line therapy for Hodgkin’s disease; combination therapy is clearly superior to single-drug therapy.

In combination with mechlorethamine, procarbazine, and prednisone (MOPP regimen) in an alternating schedule with the ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine) for the treatment of Hodgkin’s disease.

Use in other combination regimens for the treatment of advanced Hodgkin’s disease is being investigated, and comparative efficacy of various regimens is continually being evaluated.

Non-Hodgkin’s Lymphoma

Component of combination chemotherapeutic regimens as first-line palliative therapy for non-Hodgkin’s lymphomas, including the diffuse histiocytic or lymphocytic type.

Comparative efficacy of various regimens is continually being evaluated, and the best combination or sequence to achieve maximum response has not been established.

Neuroblastoma

Component of various regimens as second-line palliative therapy for neuroblastoma.

Rhabdomyosarcoma

Commonly used with dactinomycin, with or without cyclophosphamide, as an adjunct to surgery and/or radiation therapy.

Wilms’ Tumor

In children with Wilms’ tumor, generally used with dactinomycin (with or without doxorubicin or cyclophosphamide), but the best combination or sequential therapy to achieve maximum response and duration of survival has not been established and comparative efficacy is continually being evaluated.

Combination chemotherapy is superior to single-drug therapy as an adjunct to surgery and/or radiation therapy in prolonging relapse-free survival and overall survival.

Brain Tumors

Palliative treatment of various primary brain tumors†.

Various first- and second-line regimens that typically include vincristine and lomustine with another antineoplastic agent, such as procarbazine or cisplatin, or a corticosteroid (prednisone) have been used in the treatment of astrocytic tumors (e.g., glioblastoma multiforme and anaplastic astrocytoma), medulloblastoma, and oligodendroglioma.

AIDS-related Kaposi’s Sarcoma

Used alone or in combination chemotherapy for the palliative treatment of AIDS-related Kaposi’s sarcoma†.

Small Cell Lung Cancer

In combination with cyclophosphamide and doxorubicin (CAV) for the treatment of extensive-stage small cell lung cancer†.

Response rates of 70–85% and complete response rates of 20–30% in patients with extensive-stage disease, but survival outcomes are similar with CAV or cisplatin/etoposide, and comparative efficacy is continually being evaluated.

Current prognosis for small cell lung carcinoma is unsatisfactory regardless of stage; all patients are candidates for inclusion in clinical trials at the time of diagnosis.

Other Uses

Used in combination chemotherapy for osteosarcoma (including Ewing's sarcoma), multiple myeloma, and choriocarcinoma.

Used in combination with cyclophosphamide and prednisone (with or without doxorubicin) for chronic lymphocytic leukemia.

Used in combination with cyclophosphamide and dacarbazine for pheochromocytoma.

Has been used for treatment of immune thrombocytopenic purpura. Used IV with some success for the treatment of thrombotic thrombocytopenic purpura†, and the use of vincristine-loaded platelets has reportedly been useful in some cases for the management of autoimmune hemolytic anemia†.