In an earlier post, I commented on the use of two wonder drugs (vincristine and vinblastine) isolated from the beautiful Madagascar periwinkle (Periwinkle, Pervenche, Vinca rosea, Cantharanthus roseus).
I am revisiting the periwinkle because of some great breaking news (October 24, 2024) in the use of its constituents in combatting Hodgkin’s lymphoma, a blood cancer originating from one type of white blood cells (lymphocytes, Reed-Sternberg cells). The prognosis for this type of lymphoma was already very good, relative to many other cancers, with careful choice of combination chemotherapy that includes one of the periwinkle drugs. In a major well-designed trial of 994 patients published this month, the hitherto success rate has been improved even further.
The investigators used a combination of vinblastine with doxorubicin, dacarbazine and an immunotherapy drug nivolumab. At 2 years, 92% of the patients showed no progression of disease as compared with 83% with the previously ‘best’ therapy which also included vinblastine. Hodgkin’s lymphoma patients older than 60 years of age who generally have a poorer outcome did remarkably well (88% compared with 65%).
What is perhaps more remarkable is that since their discovery, the periwinkle vinblastine and vincristine have been in every major improvement in the treatment of Hodgkin’s lymphoma. Therefore, the history of the discovery of the beneficial effects of the periwinkle drugs is perhaps worth repeating here. For more, please see my earlier post on the periwinkle.
In the 1950s, learning of its long history of use in the West Indies as an antidiabetic agent, Ralph Noble in Canada and Gordon Svoboda in the US investigated the plant as a possible source of novel orally active antidiabetic medicines. Insulin which required frequent injections, was then the only effective antidiabetic agent available. Periwinkle had no effect on blood glucose but the researchers observed that the plant extracts killed mice when given by injection. With great lateral thinking they reasoned that if, as observed, it destroyed white blood cells, it might be useful for the treatment of blood cancers characterised by over-proliferation of such cells. They were right. Today, over seven decades after their discovery, vincristine and vinblastine are first-line drugs in combination chemotherapy of several cancers including Hodgkin’s lymphoma.
For further reading: Herrera Alex F, LeBlanc M, Castellino Sharon M, et al. Nivolumab+AVD in Advanced-Stage Classic Hodgkin’s Lymphoma. New England Journal of Medicine 2024;391:1379-89.
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