Vincristine in haematological malignancies: A cornerstone alkaloid in modern cancer chemotherapy

Abstract

Vincristine sulfate, a naturally occurring vinca alkaloid from Catharanthus roseus, remains a crucial component of polychemotherapeutic regimens for a wide range of haematological malignancies, including acute lymphoblastic leukemia (ALL), Hodgkin's lymphoma, and non-Hodgkin's lymphomas. Vinca alkaloid relies on its antineoplastic property to interfere with the microtubule’s dynamics, thereby, it stops mitosis, inducing apoptotic cascades in rapidly dividing cells. Vincristine is being utilised in chemotherapy formulation due to its high-affinity binding to tubulin dimers, which inhibits microtubule assembly and induces mitotic arrest and apoptosis during the mitotic M-phase of the cell cycle. Since lymphoid and myeloid neoplasms proliferate quickly, vincristine offers a targeted cytotoxic advantage with a distinct, bone-marrow-sparing toxicity profile. As vincristine does not significantly impair myelosuppression, it can be incorporated into dose-intensive, multi-drug regimens that have greatly increased survival rates in both adult and paediatric populations. However, its clinical utility is often challenged by dose-limiting peripheral neurotoxicity and emerging resistance mechanisms. There is a substantial gap in standardised vincristine toxicity assessment, pharmacogenomic prediction, and targeted drug delivery systems, highlighting the need for continued investigation. This review investigates current pharmacological aspects and clinical outcomes, vincristine’s status as a therapeutic agent in curative-intent regimens while evaluating recent innovations, like liposomal formulation and structural modifications, designed to enhance delivery and mitigate adverse effects like toxicity and other oncologic factors, including its clinical uses and limitations.