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ALERT: U.S. Boxed Warning
The FDA-approved labeling includes a boxed warning. See Warnings/Precautions section for a concise summary of this information. For verbatim wording of the boxed warning, consult the product labeling or www.fda.gov.
Medication Safety Issues
Sound-alike/look-alike issues:
VinBLAStine may be confused with vinCRIStine, vinorelbine
High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
Note: Must be dispensed in overwrap which bears the statement "Do not remove covering until the moment of injection. Fatal if given intrathecally. For I.V. use only." Syringes should be labeled: "Fatal if given intrathecally. For I.V. use only."
Pronunciation
(vin BLAS teen)
Index Terms
Generic Available
Yes
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of Hodgkin's and non-Hodgkin's lymphoma; testicular cancer; breast cancer; mycosis fungoides; Kaposi's sarcoma; histiocytosis (Letterer-Siwe disease); choriocarcinoma
Use: Unlabeled/Investigational
Treatment of bladder cancer, melanoma, nonsmall cell lung cancer (NSCLC), ovarian cancer, soft tissue sarcoma (desmoid tumors)
Pregnancy Risk Factor
D
Pregnancy Considerations
Animal studies have demonstrated resorption and teratogenic effects. There are no adequate and well-controlled studies in pregnant women. Women of childbearing potential should avoid becoming pregnant during vinblastine treatment. Aspermia has been reported in males who have received treatment with vinblastine.
Lactation
Excretion in breast milk unknown/not recommended
Breast-Feeding Considerations
Due to the potential for serious adverse reactions in the nursing infant, breast-feeding is not recommended.
Contraindications
Significant granulocytopenia; presence of bacterial infection; I.T. administration is contraindicated (may result in death)
Warnings/Precautions
Boxed warnings:
• Experienced physician: See “Other warnings/precautions” below.
• NOT for intrathecal use: See “Other warnings/precautions” below.
• Vesicant: See “Other warnings/precautions” below.
Special handling:
• Hazardous agent: Use appropriate precautions for handling and disposal. Avoid eye contamination (exposure may cause severe irritation).
Concerns related to adverse effects:
• Bone marrow suppression: Leukopenia is common; granulocytopenia may be severe with higher doses. Leukopenia may be more pronounced in cachectic patients and patients with skin ulceration. Thrombocytopenia and anemia may occur rarely.
• Neurotoxicity: May rarely cause disabling neurotoxicity; usually reversible.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment; toxicity may be increased; may require dosage modification.
• Ischemic heart disease: Use with caution in patients with ischemic heart disease.
Concurrent drug therapy issues:
• Itraconazole: Itraconazole may decrease the metabolism of vinblastine via CYP3A4 inhibition and may increase the effects of vinblastine via P-glycoprotein effects. Severe myelosuppression and neurotoxicity may occur.
• Mitomycin C: Acute shortness of breath and severe bronchospasm have been reported, most often in association with concurrent administration of mitomycin; may occur within minutes to several hours following vinblastine administration or up to 14 days following mitomycin administration; use caution in patients with pre-existing pulmonary disease.
Dosage form specific issues:
• Benzyl alcohol: Some dosage forms may contain benzyl alcohol which has been associated with “gasping syndrome” in neonates.
Other warnings/precautions:
• Experienced physician: [U.S. Boxed Warning]: Should be administered under the supervision of an experienced cancer chemotherapy physician.
• NOT for intrathecal use: [U.S. Boxed Warning]: For I.V. use only.
Intrathecal administration may result in death. Must be dispensed in overwrap which bears the statement "Do not remove covering until the moment of injection. Fatal if given intrathecally. For I.V. use only."
• Vesicant: [U.S. Boxed Warning]: Vinblastine is a moderate vesicant; avoid extravasation. Individuals administering should be experienced in vinblastine administration. Assure proper needle or catheter placement prior to administration.
Adverse Reactions
Frequency not defined.
Common:
Cardiovascular: Hypertension
Central nervous system: Malaise
Dermatologic: Alopecia
Gastrointestinal: Constipation
Hematologic: Myelosuppression, leukopenia/granulocytopenia (nadir: 5-10 days; recovery: 7-14 days; dose-limiting toxicity)
Neuromuscular & skeletal: Bone pain, jaw pain, tumor pain
Less common:
Cardiovascular: Angina, cerebrovascular accident, coronary ischemia, ECG abnormalities, MI, Raynaud's phenomenon
Central nervous system: Depression, dizziness, headache, neurotoxicity (duration: >24 hours), seizure, vertigo
Dermatologic: Dermatitis, photosensitivity (rare), rash, skin blistering
Endocrine & metabolic: Aspermia, hyperuricemia, SIADH
Gastrointestinal: Abdominal pain, anorexia, diarrhea, gastrointestinal bleeding, hemorrhagic enterocolitis, ileus, metallic taste, nausea (mild), paralytic ileus, rectal bleeding, stomatitis, vomiting (mild)
Genitourinary: Urinary retention
Hematologic: Anemia, thrombocytopenia (recovery within a few days)
Local: Cellulitis (with extravasation), irritation, phlebitis (with extravasation), radiation recall
Neuromuscular & skeletal: Deep tendon reflex loss, myalgia, paresthesia, peripheral neuritis, weakness
Ocular: Nystagmus
Otic: Auditory damage, deafness, vestibular damage
Respiratory: Bronchospasm, dyspnea, pharyngitis
Metabolism/Transport Effects
Substrate of CYP2D6 (minor), 3A4 (major); Inhibits CYP2D6 (weak), 3A4 (weak)
Drug Interactions
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Dabigatran Etexilate: P-Glycoprotein Inducers may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Deferasirox: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Echinacea: May diminish the therapeutic effect of Immunosuppressants. Risk D: Consider therapy modification
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Itraconazole: May increase the serum concentration of VinBLAStine. Risk C: Monitor therapy
Leflunomide: Immunosuppressants may enhance the adverse/toxic effect of Leflunomide. Specifically, the risk for hematologic toxicity such as pancytopenia, agranulocytosis, and/or thrombocytopenia may be increased. Management: Consider not using a leflunomide loading dose in patients receiving other immunosuppressants. Patients receiving both leflunomide and another immunosuppressant should be monitored for bone marrow suppression at least monthly. Risk D: Consider therapy modification
Lopinavir: May increase the serum concentration of VinBLAStine. Management: Monitor closely for signs and symptoms of vinblastine toxicity; consider temporary interruption of lopinavir/ritonavir antiviral therapy if patients develop significant toxicity with concurrent use. Risk D: Consider therapy modification
Macrolide Antibiotics: May increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Macrolides may also increase the distribution of Vinca Alkaloids into certain cells and/or tissues. Management: Consider an alternative to using a macrolide antibiotic when possible in order to avoid the potential for increased vinca alkaloid toxicity. Exceptions: Azithromycin. Risk D: Consider therapy modification
MAO Inhibitors: May enhance the orthostatic effect of Orthostasis Producing Agents. Risk C: Monitor therapy
Mitomycin: Antineoplastic Agents (Vinca Alkaloids) may enhance the adverse/toxic effect of Mitomycin. Specifically, the risk of pulmonary toxicity may be increased. Risk C: Monitor therapy
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab. Specifically, the risk of concurrent infection may be increased. Risk X: Avoid combination
Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy
P-Glycoprotein Inducers: May decrease the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
P-Glycoprotein Inhibitors: May increase the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
P-Glycoprotein Substrates: P-Glycoprotein Inducers may decrease the serum concentration of P-Glycoprotein Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Risk C: Monitor therapy
Posaconazole: May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Posaconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Risk D: Consider therapy modification
Ritonavir: May increase the serum concentration of VinBLAStine. Management: Monitor closely for signs and symptoms of vinblastine toxicity; consider temporary interruption of ritonavir antiviral therapy if patients develop significant toxicity with concurrent use. Risk D: Consider therapy modification
Tolterodine: VinBLAStine may increase the serum concentration of Tolterodine. Management: Reduce tolterodine dose to 1 mg twice daily (regular release formulation) or 2 mg daily (extended release formulation) (adult doses) and monitor for increased levels/effects of tolterodine with initiation of vinblastine therapy. Risk D: Consider therapy modification
Trastuzumab: May enhance the neutropenic effect of Immunosuppressants. Risk C: Monitor therapy
Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Risk C: Monitor therapy
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines (Live). Vaccinial infections may develop. Immunosuppressants may diminish the therapeutic effect of Vaccines (Live). Management: Avoid use of live virus vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Risk X: Avoid combination
Voriconazole: May enhance the adverse/toxic effect of Antineoplastic Agents (Vinca Alkaloids). Voriconazole may increase the serum concentration of Antineoplastic Agents (Vinca Alkaloids). Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Herb/Nutraceutical: Avoid St John's wort (may decrease vinblastine levels). Avoid black cohosh, dong quai in estrogen-dependent tumors.
Storage
Note: Must be dispensed in overwrap which bears the statement “Do not remove covering until the moment of injection. Fatal if given intrathecally. For I.V. use only.” Syringes should be labeled: “Fatal if given intrathecally. For I.V. use only.”
Store intact vials under refrigeration at 2°C to 8°C (36°F to 46°F). Protect from light. Solutions reconstituted in bacteriostatic NS are stable for 28 days under refrigeration.
Reconstitution
Reconstitute lyophilized powder to a concentration of 1 mg/mL with NS or bacteriostatic NS. For infusion, may dilute in 50 mL NS or D5W; dilution in larger volumes (?100 mL) of I.V. fluids is not recommended. Use appropriate precautions for handling and disposal.
Compatibility
Stable in D5W, LR, NS
Y-site administration: Compatible: Allopurinol, amifostine, amphotericin B cholesteryl sulfate complex, aztreonam, bleomycin, cisplatin, cyclophosphamide, doxorubicin, doxorubicin liposome, droperidol, etoposide phosphate, filgrastim, fludarabine, fluorouracil, gatifloxacin, gemcitabine, granisetron, heparin, leucovorin calcium, melphalan, methotrexate, metoclopramide, mitomycin, ondansetron, paclitaxel, piperacillin/tazobactam, sargramostim, teniposide, thiotepa, vincristine, vinorelbine. Incompatible: Cefepime, furosemide, lansoprazole.
Compatibility in syringe: Compatible: Bleomycin, cisplatin, cyclophosphamide, droperidol, fluorouracil, leucovorin calcium, methotrexate, metoclopramide, mitomycin, vincristine. Incompatible: Furosemide. Variable (consult detailed reference): Doxorubicin, heparin.
Compatibility when admixed: Compatible: Bleomycin, dacarbazine. Variable (consult detailed reference): Doxorubicin.
Mechanism of Action
Vinblastine binds to tubulin and inhibits microtubule formation, therefore, arresting the cell at metaphase by disrupting the formation of the mitotic spindle; it is specific for the M and S phases. Vinblastine may also interfere with nucleic acid and protein synthesis by blocking glutamic acid utilization.
Pharmacodynamics/Kinetics
Distribution: Vd: 27.3 L/kg; binds extensively to tissues; does not penetrate CNS or other fatty tissues; distributes to liver
Protein binding: 99%
Metabolism: Hepatic to active metabolite
Half-life elimination: Biphasic: Initial: 4 minutes; Terminal: 25 hours
Excretion: Feces (95%); urine (<1% as unchanged drug)
Dosage
Details concerning dosing in combination regimens should also be consulted. Note: Frequency and duration of therapy may vary by indication, concomitant combination chemotherapy and hematologic response. For I.V. use only.
Children: I.V.:
Hodgkin's disease: Initial dose: 6 mg/m2; do not administer more frequently than every 7 days
Letterer-Siwe disease: Initial dose: 6.5 mg/m2; do not administer more frequently than every 7 days
Testicular cancer: Initial dose: 3 mg/m2; do not administer more frequently than every 7 days
Adults: I.V.: Initial: 3.7 mg/m2; adjust dose every 7 days (based on white blood cell response) up to 5.5 mg/m2 (second dose); 7.4 mg/m2 (third dose); 9.25 mg/m2 (fourth dose); and 11.1 mg/m2 (fifth dose); do not administer more frequently than every 7 days.
Usual range: 5.5-7.4 mg/m2 every 7 days; Maximum dose: 18.5 mg/m2; dosage adjustment goal is to reduce white blood cell count to ~3000/mm3
Indication-specific dosing:
Hodgkin's disease: Usual dose: 6 mg/m2 every 2 weeks (as part of a combination chemotherapy regimen) (Bartlett, 1995; Horning, 2002)
Testicular cancer: Usual dose: 0.11 mg/kg daily for 2 days every 3 weeks (as part of a combination chemotherapy regimen) (Loehrer, 1998) or 6 mg/m2/day for 2 days every 3-4 weeks (as part of a combination chemotherapy regimen) (Clemm, 1986)
Bladder cancer (unlabeled use): Usual dose: 3 mg/m2 every 7 days for 3 out of 4 weeks (as part of combination chemotherapy) (Sternberg, 2001) or 3 mg/m2 days 2, 15, and 22 of a 28-day treatment cycle (as part of a combination chemotherapy regimen) (von der Maase, 2000)
Melanoma (unlabeled used): 2 mg/m2 days 1-4 and 22-25 of a 6-week treatment cycle (as part of a combination chemotherapy regimen) (Eton, 2002)
Nonsmall cell lung cancer (unlabeled use): 4 mg/m2 days 1, 8, 15, 22, and 29, then every 2 weeks (as part of combination chemotherapy) (Arriagada, 2004)
Ovarian cancer (unlabeled use): 0.11 mg/kg daily for 2 days every 3 weeks (as part of a combination chemotherapy regimen) (Loehrer, 1998)
Dosing adjustment in renal impairment: According to FDA-approved labeling, no adjustment is necessary in patients with renal impairment.
Dosing adjustment in hepatic impairment:
The FDA-approved labeling recommends the following guidelines: Serum bilirubin >3 mg/dL: Administer 50% of dose
The following guidelines have been used by some clinicians:
Serum bilirubin >3.1 or transaminases >3 times ULN: Avoid use (Floyd, 2006) or
Serum bilirubin 1.5-3 mg/dL or AST 60-180 units: Administer 50% of dose
Serum bilirubin 3-5 mg/dL: Administer 25% of dose
Serum bilirubin >5 mg/dL or AST >180 units: Avoid use
Dosage: Combination Regimens
Bladder cancer:
CMV
M-VAC (Bladder Cancer)
Breast cancer:
M-VAC (Breast Cancer)
VATH
VM
Cervical cancer: M-VAC (Cervical Cancer)
Endometrial cancer: M-VAC (Endometrial Cancer)
Head and Neck cancer: M-VAC (Head and Neck Cancer)
Lung cancer (nonsmall cell): Cisplatin-Vinblastine (NSCLC)
Lymphoma, Hodgkin's:
ABVD
CAD/MOPP/ABV
Chlorambucil-VPP (Hodgkin's Lymphoma)
Etoposide-Vinblastine-Doxorubicin (Hodgkin's)
MOPP/ABV Hybrid
MOPP/ABVD
MVPP
Stanford V Regimen
Melanoma:
Cisplatin-Vinblastine-Dacarbazine (Melanoma)
CVD-Interleukin-Interferon (Melanoma)
Prostate cancer:
Doxorubicin + Ketoconazole/Estramustine + Vinblastine
Estramustine-Vinblastine
Soft tissue sarcoma: Methotrexate-Vinblastine (Desmoid Tumor)
Testicular cancer:
PVB
VBP
VIP (Vinblastine) (Testicular Cancer)
Administration: I.V.
Vesicant. Fatal if given intrathecally. For I.V. administration only, usually as a slow (2-3 minutes) push, or a bolus (5-15 minutes) infusion; the manufacturer recommends an undiluted 1-minute infusion to prevent venous irritation/extravasation. Prolonged administration times and/or increased administration volumes may the risk of vein irritation and extravasation. Assure proper needle or catheter placement prior to administration.
Administration: I.V. Detail
pH: 3.5-5.0
Monitoring Parameters
CBC with differential and platelet count, serum uric acid, hepatic function tests
Patient Education
Do not take any new medication during therapy unless approved by prescriber. This medication can only be administered by infusion; report immediately any redness, swelling, burning, or pain at infusion site; sudden difficulty breathing; swelling; chest pain; or chills. Maintain adequate hydration unless instructed to restrict fluid intake, and nutrition (small, frequent meals will help). You will be more susceptible to infection (avoid crowds and exposure to infection and do not have any vaccinations unless approved by prescriber). May cause hair loss (will grow back after therapy); nausea or vomiting (request antiemetic); photosensitivity (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight); feelings of extreme weakness or lethargy (use caution when driving or engaging in tasks requiring alertness until response to drug is known); or mouth sores (use soft toothbrush, waxed dental floss, and frequent oral care). Report persistent constipation or abdominal pain; numbness or tingling in fingers or toes (use care to prevent injury); weakness or pain in muscles or jaw; signs of infection (eg, fever, chills, sore throat, burning urination, fatigue); unusual bleeding (eg, tarry stools, easy bruising, blood in stool, urine, or mouth); unresolved mouth sores; skin rash or itching; or respiratory difficulty. Pregnancy/breast-feeding precautions: Do not get pregnant (females) or cause a pregnancy (males) during this therapy. Consult prescriber for appropriate contraceptive measures. Breast-feeding is not recommended.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Stomatitis, metallic taste, and jaw pain.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause depression
Mental Health: Effects on Psychiatric Treatment
Bone marrow suppression is common; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Use caution with impaired liver function. Assess potential for interactions with other pharmacological agents and herbal products patient may be taking (eg, previous or concurrent use mitomycin-C can cause severe reaction). Premedication with antiemetic is advisable. Infusion site must be monitored closely to prevent extravasation (vesicant will cause tissue damage and necrosis). Assess results of laboratory tests, renal function, and adverse reactions (eg, SIADH, bone marrow suppression, leukopenia, hypertension, gastrointestinal disturbance, myalgia, depression, paresthesia) prior to each infusion and throughout therapy. Teach patient possible side effects/appropriate interventions and adverse symptoms to report.
Oncology: Emetic Potential
Very low (<10%)
Oncology: Vesicant
Yes; see Management of Drug Extravasations.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, powder for reconstitution, as sulfate: 10 mg
Injection, solution, as sulfate: 1 mg/mL (10 mL) [contains benzyl alcohol]
References
Arriagada R, Bergman B, Dunant A, et al, “Cisplatin-Based Adjuvant Chemotherapy in Patients With Completely Resected Non-Small-Cell Lung Cancer,” N Engl J Med, 2004, 350(4):351-60.
Bartlett NL, Rosenberg SA, Hoppe RT, et al, “Brief Chemotherapy, Stanford V, and Adjuvant Radiotherapy for Bulky or Advanced-Stage Hodgkin's Disease: A Preliminary Report,” J Clin Oncol, 1995, 13(5):1080-8.
Bashir H, Motl S, Metzger ML, et al, “Itraconazole-Enhanced Chemotherapy Toxicity in a Patient With Hodgkin Lymphoma,” J Pediatr Hematol Oncol, 2006, 28(1):33-5.
Bonadonna G, Valagussa P, and Santoro A, “Alternating Non-Cross-Resistant Combination Chemotherapy or MOPP in Stage IV Hodgkin's Disease: A Report of 8-Year Results,” Ann Intern Med, 1986, 104(6):739-46.
Chong CD, Logothetis CJ, Savaraj N, et al, “The Correlation of Vinblastine Pharmacokinetics to Toxicity in Testicular Cancer Patients,” J Clin Pharmacol, 1998, 28(8):714-8.
Clemm C, Hartenstein R, Willich N, et al, “Vinblastine-Ifosfamide-Cisplatin Treatment of Bulky Seminoma,” Cancer, 1986, 58(10):2203-7.
Eton O, Legha SS, Bedikian AY, et al, “Sequential Biochemotherapy Versus Chemotherapy for Metastatic Melanoma: Results From a Phase III Randomized Trial,” J Clin Oncol, 2002, 20(8):2045-52.
Floyd J, Mirza I, Sachs B, et al, "Hepatotoxicity of Chemotherapy," Semin Oncol, 2006, 33(1):50-67.
Friedman M, Venkatesan TK, and Caldarelli DD, “Intralesional Vinblastine for Treating AIDS-Associated Kaposi's Sarcoma of the Oropharynx and Larynx,” Ann Otol Rhinol Laryngol, 1996, 105(4):272-4.
Horning SJ, Hoppe RT, Breslin S, et al, “Stanford V and Radiotherapy for Locally Extensive and Advanced Hodgkin's Disease: Mature Results of a Prospective Clinical Trial,” J Clin Oncol, 2002, 20(3):630-7.
Loehrer PJ Sr, Gonin R, Nichols CR, et al, “Vinblastine Plus Ifosfamide Plus Cisplatin as Initial Salvage Therapy in Recurrent Germ Cell Tumor,” J Clin Oncol, 1998, 16(7):2500-4.
Pronzato P, Queirolo P, Vidili MG, et al, “Continuous Venous Infusion of Vinblastine in Metastatic Breast Cancer,” Chemotherapy, 1991, 37(2):146-9.
Sternberg CN, de Mulder PH, Schornagel JH, et al, “Randomized Phase III Trial of High-Dose-Intensity Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (M-VAC) Chemotherapy and Recombinant Human Granulocyte Colony-Stimulating Factor Versus Classic M-VAC in Advanced Urothelial Tract Tumors: European Organization for Research and Treatment of Cancer Protocol No. 30924,” J Clin Oncol, 2001, 19(10):2638-46.
van der Maase H, Hansen SW, Roberts JT, et al, “Gemcitabine and Cisplatin Versus Methotrexate, Vinblastine, Doxorubicin, and Cisplatin in Advanced or Metastatic Bladder Cancer: Results of a Large, Randomized, Multinational, Multicenter, Phase III Study,” J Clin Oncol, 2000, 18(17):3068-77.
Williams SD, Birch R, Einhorn LH, et al, “Treatment of Disseminated Germ-Cell Tumors With Cisplatin, Bleomycin, and Either Vinblastine or Etoposide,” N Engl J Med, 1987, 316(23):1435-40.
International Brand Names
Lexi-Comp.com
Last full review/revision October 2009
Content last modified October 2009
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