Vinflunine (Javlor)

Vinflunine is a chemotherapy drug used to treat advanced transitional cell bladder and urothelial tract cancer. It is also called Javlor. It is licensed for people who have already had cisplatin or carboplatin chemotherapy.

Research is also looking at it as a treatment for other types of cancer

Vinflunine is one of a group of drugs known as the vinca alkaloids. It works by attacking part of the cell’s structure which is made out of a protein called tubulin. So the cells can’t separate into two, which stops the growth of the cancer.

You have vinflunine as a drip (infusion) into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it 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 usually have chemotherapy as a course of several cycles of treatment. How many cycles of treatment you have depends on your treatment plan. There is detailed information about the way doctors plan chemotherapy in the planning chemotherapy section.

You have the vinflunine once every 3 weeks. The drip lasts for about 20 minutes. Before each treatment you have blood tests and so you are likely to be at the hospital for a few hours.

Medicines, foods and herbal supplements which contain CYP enzymes can interfere with how vinflunine works. Avoid grapefruit and grapefruit juice while you are having treatment.

The side effects associated with vinflunine are listed below. You can use the links to find out more about each side effect. For general information, see our cancer drug side effects 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 doctor 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

• Constipation in just over half of people (50%) – your doctor will give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• Fatigue in 1 in 2 people (50%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Loss of appetite in just over 3 out of 10 people (30%)
• Stomach pain in 1 in 5 people (20%)
• Feeling or being sick in about 4 out of every 10 people (40%), but this is usually well controlled with anti sickness drugs
• A sore mouth in 1 out of 4 people (25%)
• Diarrhoea affects just over 1 out of 10 people (10%) – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• Hair loss – about 3 out of 10 people have complete hair loss but the hair grows back once the treatment ends
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Weight loss
• Fever and chills
• This drug may have a harmful effect on a developing baby – do talk to your doctor 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 only be temporary
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with this drug, so it is important to talk to your doctor about your fertility before starting treatment if having a baby is important to you
• You should not breastfeed while having this drug as it may come through in the breast milk

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

• Numbness or tingling in fingers and toes affects up to 1 out of 10 people (10%) and 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
• Some people have an allergic reaction while having vinflunine treatment, usually at the first or second treatment – let your treatment team know immediately if you feel hot or have any skin rashes, itching, dizziness, headaches, shivering, breathlessness, anxiety, a flushed face, or a sudden need to pass urine
• Difficulty sleeping
• Taste changes
• Headaches
• Shortness of breath and a cough
• Indigestion
• Pain in the jaw, bones, back and muscles
• Skin changes – your skin may be dry, itchy and become sore

A very small number of people have kidney changes that are unlikely to cause symptoms – the kidneys will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your kidneys are working.

You won’t get all these side effects. 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. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

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

Vinflunine is a relatively new chemotherapy drug. This means that the information about side effects is based on only a few trials. And there is no information available at the moment about possible longer term effects that it may cause. If you notice anything that is not normal for you tell your doctor.

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 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 from your chemotherapy.

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.