Pharmacokinetics of Vincristine Sulfate in Adult Cancer Patients¹

Vincristine concentration in serum from 1 min to 72 hr was measured by radioimmunoassay in 14 patients with cancers following i.v. bolus injection of vincristine sulfate at 0.45 to 1.30 mg/sq m. The pharmacokinetic data were analyzed by a nonlinear least-square regression program NONLIN. A three-compartmental open model fitted the raw data better than a two-compartmental model. The mean half-lives of the triphasic decay curves α, β, and γ were 1.9, 19.2, and 1359 min (22.6 hr), respectively. The apparent volume of the central compartment and the volume of distribution at steady state (V_dss) per 1.73 sq m body surface area were 4.1 and 167.6 liters, respectively. The plasma clearance was 141.9 ml/min/1.73 sq m, and the area under the concentration × time curve from 0 to ∞ (AUC₀^∞) for 2 mg vincristine was 21,689 nm·min. Linear regression analysis of the data gave evidence for increasing plasma clearance at higher doses of vincristine. In patients with higher platelet counts, lower AUC₀^∞ values were obtained, suggesting a possible interaction of vincristine with blood platelets. Our results, a large V_dss, a long biological half-life, and a low rate-limiting rate constant from Compartment 3 to the central compartment (k₃₁), indicate an avid tissue binding and a slow drug release from the body tissues which may account for drug-related neurotoxicity.