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Vincristine, actinomycin and ifosfamide (VAI)

Find out what VAI chemotherapy is, how you have it and other important information about having VAI.

VAI is the name of a combination of chemotherapy drugs used to treat Ewing's sarcoma. It is made up of the drugs:

  • vincristine
  • actinomycin
  • ifosfamide

How it works

These cancer drugs destroy quickly dividing cells, such as cancer cells.

How you have it

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

You have these drugs into your bloodstream (intravenously). You can have them through a short tube (cannula) put into a vein in your arm each time you have treatment. Or you have them through a long line: a central line, a PICC line or a portacath.

Diagram showing a central line

These are long, plastic tubes that give the drugs into a large vein in your chest. The tube stays in place throughout the course of your treatment.

When you have it

You have VAI chemotherapy as cycles of treatment.

Each cycle of treatment lasts 3 weeks. You might have up to 8 cycles, taking 6 months in total.

You have the treatment through a drip into your cannula or central line.

Day 1
  • vincristine injection through a drip of salt water (saline)
  • actinomycin injection through a drip of salt water (saline)
  • ifosfamide as a drip - this is over a longer period of time
  • mesna as a drip or as a tablet - this is to stop the ifosfamide irritating your bladder (mesna isn't chemotherapy)
Day 2
  • actinomycin injection through a drip of salt water (saline)
  • ifosfamide as a drip - this is over a longer period of time
  • mesna as a drip or as a tablet

You have no treatment for the next 3 weeks. Then you start your next treatment cycle.


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

Side effects

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for a few 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 into your breast milk.


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.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.


Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who've had live vaccines as injections

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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