Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) as neoadjuvant chemotherapy for patients with muscle-invasive transitional cell carcinoma of the bladder
Blick C et al. – Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (AMVAC) is safe and appears to be a well–tolerated and effective neoadjuvant chemotherapy (NAC) regimen for muscle–invasive bladder cancer (MIBC). It minimizes delays to definitive treatment and produces excellent pathological and radiological response rates. It is an appropriate comparator for future randomized trials.Methods
- Eighty consecutive patients with MIBC were treated with AMVAC as NAC by 2 UK multidisciplinary uro-oncology teams.
- Three or 4 cycles of AMVAC (methotrexate 30mg/m2, vinblastine 3mg/m2, doxorubicin 30mg/m2, and cisplatin 70mg/m2) were given at 2-week intervals, with granulocyte colony-stimulating factor support, prior to either radical surgery or radical radiotherapy.
- All planned cycles of chemotherapy were completed, without dose reduction or delay in 84% of patients.
- All 80 patients subsequently received their planned definitive therapy.
- Grade 3/4 toxicities were seen in 26% of the 42% of patients for whom toxicity data are available, including 12% grade 3/4 neutropenia.
- Pathological complete response to AMVAC was seen in 43% of 60 surgical patients.
- Objective radiological local response was seen in 83% of 57 evaluable patients.
- Two-year disease-free and overall survival were 65% and 77%, respectively.