Vinflunine Tartrate

A vinca alkaloid, derived from vinorelbline, used in the treatment of various types of cancer. It is administered intravenously every 3 weeks.

Since the last update, we have not found published data on its excretion in breastmilk.

Although its pharmacokinetic data (high molecular weight and large volume of distribution) make it unlikely that it will transfer into milk in significant amounts, most experts advise against the use of antineoplastic agents during breastfeeding due to possible harmful effects on the infant (Anderson 2016, Koren 2013, Pistilli 2013, Pentheroudakis 2010) until further safety data regarding breastfeeding is available.

It is known from pharmacokinetics that after 3 elimination half-lives (T½), 87.5% of the drug is eliminated from the body; after 4 T½, 94% is eliminated, 96.9% after 5 T½, 98.4% after 6 T½ and 99% after 7 T½. 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 as reference the longest reported T½ of all active metabolites, these 5 T½ would correspond to 25 days. Due to major adverse effects, it would be advisable to wait 7 T½, which would correspond to 35 days. Meanwhile, express and discard breastmilk regularly.

The time needed to suspend breastfeeding is the same as the frequency of treatment cycles (every 21 days), makes it practically impossible to continue breastfeeding.

When possible, detections in each patient's milk to determine total drug elimination would be the best indicator for resuming breastfeeding between two cycles of chemotherapy.

Breastfeeding must be discontinued during cancer treatment due to potentially serious side effects for the infant. Chemotherapy does not affect milk production during or after treatment. Abrupt weaning can be psychologically traumatic for both mother and infant (Pistilli 2013).

If the mother wishes, milk production can be maintained by regularly expressing breastmilk, and breastfeeding can occur in periods when there are no significant traces of the drug in breastmilk (Anderson 2016) or at the end of treatment (Pistilli 2013).

Some chemotherapeutic agents with antibiotic effects can alter the composition of the microbiota (group of bacteria or bacterial flora) in milk and the concentration of some of its components (Urbaniak 2014). This possibly occurs temporarily with subsequent recovery, without any harmful effects being recorded in breastfed infants.

Women in chemotherapy during pregnancy have lower breastfeeding rates due to difficulties with breastfeeding (Stopenski 2017), needing more support to achieve it.

Given the amount of evidence that exists on the benefits of breastfeeding for the development of babies and the health of mothers, it is advisable to assess 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:

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