Accelerated MVAC chemotherapy in patients with advanced bladder cancer previously treated with a platinum-gemcitabine regimen.

Abstract

BACKGROUND:

Gemcitabine plus cisplatinum was shown to exert comparable activity and a different toxicity profile when compared to the methotrexate, vinblastine, doxorubicin, cisplatinum (MVAC) regimen in patients with advanced bladder cancer. Accelerated MVAC (aMVAC, the four drugs being administered every 2 weeks with granulocyte colony-stimulating factor (G-CSF)) is better tolerated than conventional MVAC, with a trend for improved activity. There is no standard of care after failure of gemcitabine-platinum (GP) chemotherapy. Our aim was to assess the activity and toxicity of accelerated MVAC as second-line treatment.

METHODS:

We reviewed data from patients previously treated with GP who had received aMVAC at two institutions at the time of disease progression.

RESULTS:

Forty-five patients received aMVAC after GP: 18 (40%) and 27 (60%) had received GP in the adjuvant and the metastatic settings, respectively. The median time to progression (TTP) after first-line GP was 9.3 months. The response rate for aMVAC was 61%, including 4/38 (10%) complete responses. Median time to progression and median overall survival (OS) were 5.8 and 14.2 months, respectively. Median TTP and OS were 9.6 and 16.5 months when GP was used in the adjuvant setting and 4.4 and 5.7 months when GP was used in the metastatic setting. Grade 3-4 toxicities were observed in 31 patients (69%), including four sepsis-related deaths.

CONCLUSION:

aMVAC exerts clinical activity after previous treatment with GP, especially when GP was used in the adjuvant setting. aMVAC should however be administered with caution due to toxicity.

• Authors: Julien Edeline, Yohann Loriot, Stephane Culine, Christophe Massard, Laurence Albiges, Aurore Blesius, Bernard Escudier, Karim Fizazi
• Journal: European journal of cancer (Oxford, England : 1990) (Eur J Cancer) Vol. 48 Issue 8 Pg. 1141-6 (May 2012) ISSN: 1879-0852 [Electronic] England
• PMID: 22364733 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Ltd. All rights reserved.

Chemical References

• Deoxycytidine
• Vinblastine
• Doxorubicin
• Cisplatin
• Methotrexate
• Gemcitabine

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Cisplatin (administration & dosage, adverse effects)
• Deoxycytidine (administration & dosage, analogs & derivatives)
• Disease-Free Survival
• Doxorubicin (administration & dosage, adverse effects)
• Female
• Humans
• Male
• Methotrexate (administration & dosage, adverse effects)
• Middle Aged
• Urinary Bladder Neoplasms (drug therapy, mortality)
• Vinblastine (administration & dosage, adverse effects)
• Gemcitabine