L01CA04

Semi-synthetic vinca alkaloid with an anti-neoplastic activity similar to Vinblastine (see specific info).
Indicated for the treatment of certain forms of lung and breast cancer.
Routes of administration: intravenous and oral.

At latest update relevant published data were not found on excretion into breast milk.

In spite of a pharmacokinetic data (large volume of distribution, molecular weight and high binding capacity to blood cells, especially to platelets) that would make it unlikely the passage to milk of significant amounts along with a low bioavailability that would hinder the passage to infant plasma, most experts advise against the use of anti-neoplastic drugs during lactation due to a potential harmful effect on the infant (Anderson 2016, Koren 2013, Pistilli 2013, Pentheroudakis 2010) until safety data with relation to breastfeeding are provided.

It is known from pharmacokinetics that after 3 elimination half-lives (T½), 87.5% of the drug is eliminated from the organism; after 4 T½ it is 94%, after 5 T½, 96.9%, after 6 T½, 98.4% and after 7 T½, 99%. From 7 T½ the plasma concentrations of the drug in the body are negligible. In general, a period of at least five half-lives can be considered a safe waiting period before breastfeeding again (Anderson 2016).

Taking the longest published T½ of all the active metabolites (44 hours) as a reference, these 5 T½ would correspond to 9 days. Due to major side effects, it would be advisable to wait 7 T½, which would correspond to 13 days. Meanwhile, express and discard milk from the breast regularly to maintain production.

The pattern of administration and the long elimination half-life make it very difficult to continue breastfeeding during treatment.
When it is possible to do so, milk detections of each patient to determine the total elimination of the drug would be the best indicator to resume breastfeeding between two cycles of chemotherapy.

Chemotherapy does not affect milk production during or after treatment.

Abrupt weaning can be psychologically traumatic for both the mother and the infant (Pistilli 2013). If the mother wishes, production of milk can be maintained by regularly expressing breastmilk, being able to resume breastfeeding in the periods in which no significant traces of the drug remain in the milk (Anderson 2016) or at the end of the treatment (Pistilli 2013).

Some chemotherapeutic agents with an antibiotic effect can alter the composition of the microbiota (bacterial set or bacterial flora) of the milk and the concentration of some of its components (Urbaniak 2014). This possibly occurs temporarily with subsequent recovery, although no harmful effects are assumed or have been reported in breastfed infants.

Women undergoing chemotherapy during pregnancy have lower rates of breastfeeding because they experience difficulties in breastfeeding (Stopenski 2017), needing more support to achieve it.

Given the strong evidence that exists regarding the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to evaluate the risk-benefit of any maternal treatment, including chemotherapy, individually advising each mother who wishes to continue with breastfeeding (Koren 2013).

See below the information of this related product:

• Vinblastine sulfate (Very unsafe. Contraindicated. Use of an alternative or cessation of breastfeeding. Read the Commentary.)