VAI

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

• Vincristine
• Actinomycin D (Dactinomycin)
• Ifosfamide

The links above take you to information about the individual side effects of each drug.

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

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 VAI 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 just before your course of treatment starts and it stays in place as long as you need it.

You have each cycle of treatment in the following way

• On the first day you have short drips (infusions) of dactinomycin and vincristine. You also have a longer drip of ifosfamide
• On the second day you have a short drip of dactinomycin 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.

The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with VAI are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.

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

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your hospital if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness 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 but the hair grows back once the treatment ends
• Feeling or being sick is usually well controlled with anti sickness drugs
• 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 fluid 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 do 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)
• These drugs may have a harmful effect on a developing baby – do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility – VAI drugs can affect your fertility so do talk with your doctor before starting treatment if having a baby is important to you

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

• Inflammation around the drip site – if you notice any signs of redness, pain swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Cystitis (inflammation of the bladder) can cause pain and occasionally bleeding when passing urine – you should drink  1 to 2 litres of fluid a day and will also have extra fluids through the drip. If you see blood in your urine, contact your doctor or nurse straight away
• Fever or chills
• Feeling depressed
• Abdominal 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 immediately

Fewer than 1 in 100 people have these.

• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• 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

Not everyone will get these side effects. You may have one or two or several. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

• How many times you've had a drug before
• Your general health
• How much of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them.

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

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.