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Vinflunine (Javlor)

Vinflunine is also called Javlor. It is a chemotherapy drug used to treat:

  • advanced cancer of the bladder
  • advanced cancer of the tube that connects the bladder to the outside of the body (the urethra)
  • advanced cancer of the centre part of the kidney (the renal pelvis)

You might have vinflunine if you have already had cisplatin or carboplatin chemotherapy. You may also have it as part of research for other types of cancer. 

How it works

Vinflunine is from a group of drugs known as the vinca alkaloids. 

It works by attacking part of the cell's structure that is made out of a protein called tubulin. So the cells can't separate into 2, which stops the growth of the cancer. 

How you have it

You have vinflunine into your bloodstream (intravenously). It takes about 20 minutes each time. 

Before each treatment you have blood tests so you are likely to be at the hospital for a few hours. 

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

You usually have vinflunine once every 3 weeks. Your doctor will tell you the number of treatments you may need. 

Tests

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

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

Each of these effects happens in more than 10 in every 100 people (more than 10%). You might have one or more of them. They include:

An increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleed

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Loss of appetite and weight loss

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Diarrhoea 

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

You are more likely to have constipation than diarrhoea when having vinflunine.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Sore mouth

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Stomach pain

Speak to your doctor or nurse if you have stomach pain.

Muscle pain

You might have muscle pain during treatment. Let your treatment team know so they can advise you on how to reduce it.

Inflammation around drip site

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

A high temperature (fever)

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Low levels of sodium in your blood

You may have changes in levels of minerals and salts in your blood, such as low sodium. This will most likely go back to normal when you finish treatment. You have regular blood tests during treatment to check this.

Numbness or tingling in fingers or toes (peripheral neuropathy)

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Occasional side effects

Each of these effects happens in 1 to 10 in every 100 people (1 to 10%). You might have one or more of them. They include:

  • an allergic reaction usually happens in the first or second treatment
  • skin changes such as such as dryness, itching, rashes and reddening
  • difficulty sleeping
  • sweating and chills
  • taste changes
  • headaches
  • shortness of breath and cough
  • chest pain
  • indigestion
  • higher or lower blood pressure
  • dehydration
  • pain in your back, mouth, joints, bones and ears
  • muscle weakness
  • dizziness
  • a fast heart beat
  • general swelling due to a build up of fluid in your body
  • swollen, red gums and teeth problems
  • a high temperature and an infection
  • blood clots
  • inflammation of the vein
  • blockage of the bowel

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • kidney changes - you have regular blood tests to make sure your kidneys are working well
  • you might gain weight
  • sore, gritty, red eyes
  • pain when swallowing
  • problems with hearing such as ringing in the ears (tinnitus)
  • muscle stiffness - this can happen during and after treatment
  • liver problems - usually mild, doesn't cause symptoms and goes back to normal when treatment is finished
  • pain where your cancer is
  • heart problems

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medications, 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.

You should not eat grapefruit or drink grapefruit juice when you are taking this drug because it can react with the drug.

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 with this drug and for at least 3 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Treatments 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.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the 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)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More 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.