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What VAI is

VAI is the name of a combination of chemotherapy drugs used to treat a type of bone cancer called Ewing’s sarcoma. It is made up of the drugs

  • V – Vincristine
  • A – Actinomycin
  • I – Ifosfamide (Mitoxana)

How VAI works

The chemotherapy drugs in the VAI combination destroy quickly dividing cells such as cancer cells. 


How you have VAI

You usually have VAI chemotherapy after surgery. Before your surgery you may also have another type of combination chemotherapy called VIDE.

You have the drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

You have VAI chemotherapy as cycles of treatment. Each cycle of treatment lasts 3 weeks. Depending on your needs, you may have up to 8 cycles, taking 6 months in total.

You have each cycle of treatment in the following way

  • On the 1st day you have short drips (infusions) of actinomycin and vincristine. You also have a longer drip of ifosfamide
  • On the 2nd day you have a short drip of actinomycin and the ifosfamide again. You also have another drug called mesna either as a tablet or as a drip. Mesna helps to protect the bladder from bleeding when you have the ifosfamide
  • You have no treatment for the next 3 weeks and then start your next treatment cycle

Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.


About side effects

We've listed the side effects associated with VAI. You can use the links to find out more about each side effect. Where there is no link, please go to our information about cancer drug side effects or use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)

The side effects may be different if you are having VAI with other medicines.

Tell your doctor or nurse straight away if any of the side effects get severe.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
  • (Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Hair loss – most people have complete hair loss starting around 2 weeks after beginning treatment. The hair grows back once the treatment ends
  • Feeling or being sick is usually well controlled with anti sickness medicines
  • Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons. This starts within a few days or weeks and usually goes within a few months of finishing treatment
  • A sore mouth
  • Loss of appetite
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
  • Constipation – your doctor or nurse may give you laxatives to help prevent this but tell them if you are constipated for more than 3 days
  • Skin changes – you may have darkening of your skin, particularly along the vein where you have your injection if you have treatment through a cannula
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Inflammation around the drip siteif you notice any signs of redness, pain swelling or leaking at your drip site, tell your chemotherapy nurse straight away
  • Cystitis (inflammation of the bladder) can cause pain and occasionally bleeding when passing urine. Drink 1 to 2 litres of fluid a day. You will also have extra fluids through the drip. If you see blood in your urine, contact your doctor or nurse straight away
  • A high temperature (fever) or chills
  • Feeling sad or depressed
  • Abdominal (tummy) cramps
  • Your nails may darken or become ridged
  • Taste changes
  • About one person in 8 has confusion, sleepiness or extreme lack of energy (lethargy) and hallucinations – if you have any of these, it is important to tell your doctor or nurse straight away

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Liver changes that are very mild and unlikely to cause symptoms. The liver will almost certainly go back to normal when treatment is finished
  • Damage to heart muscle, which is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment
  • A cough or breathlessness due to changes in lung tissue

Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Don't breastfeed during this treatment because the drug may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information


More information about VAI

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about these drugs look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 15 September 2015