[Combination chemotherapy with M-VAC protocol in metastatic urothelial cancer].

Abstract

The treatment of metastatic urothelial cancer is based on the combination of cisplatin, methotrexate, vinblastine and adriamycin (M-VAC). From November 1994 to May 1997 we treated 25 patients (51 men, 3 women, aged 50-77) with M-VAC. The tumor originated from the urinary bladder in 14 (56%) and the upper urinary tract in 11 (44%). Disease sites included: primary--5 (25%), lymph nodes--17 (68%), lungs--10 (40%), bones--8 (32%), pelvic mass and liver each--4 (16%), with an overall median of 2 (1-5) sites per patient. 9 patients (38%) had complete responses and 8 (32%) had partial responses, for an overall response rate of 68% (95% CI 48.5%-85%). The median duration of response was 15.3 (1.6-29.6+) months. Median survival of responders was 19.1 (4.8-35.7+) months compared to 6.2 (0.7-11.2) for the non-responders (p < 0.05). 13 (52%) of patients are alive, of whom 8 (32%) are free of disease and 5 with a single metastatic site on presentation at follow-up. In the 118 treatment cycles we observed grade III-IV toxicity: myelosuppression 53 (45%), thrombocytopenia 4 (3%), stomatitis 8 (6.7%), diarrhea 3 (2.5%). There were 22 infectious episodes and 1 patient died of sepsis. We achieved a high response rate with the combination M-VAC. However, only a third had long-term disease-free states and treatment was associated with excessive toxicity. Therapeutic approaches with new agents are required to improve the response rate and toxicity.

• Authors: A Sella, D Flex, D Gafni, O Rabinovitz, A Sulkes, J Baniel
• Journal: Harefuah (Harefuah) Vol. 136 Issue 4 Pg. 268-71, 340, 339 (Feb 15 1999) ISSN: 0017-7768 [Print] Israel
• PMID: 10914214 (Publication Type: Clinical Trial, English Abstract, Journal Article)

Chemical References

• Hematopoietic Cell Growth Factors
• Vinblastine
• Doxorubicin
• Cisplatin
• Methotrexate

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Carcinoma, Transitional Cell (drug therapy, pathology)
• Cisplatin (administration & dosage, adverse effects)
• Doxorubicin (administration & dosage, adverse effects)
• Female
• Hematopoietic Cell Growth Factors (therapeutic use)
• Humans
• Male
• Methotrexate (administration & dosage, adverse effects)
• Middle Aged
• Neoplasm Metastasis
• Survival Rate
• Urinary Bladder Neoplasms (drug therapy, mortality, pathology)
• Urologic Neoplasms (drug therapy, mortality, pathology)
• Urothelium
• Vinblastine (administration & dosage, adverse effects)