title: Long-term results with M-VAC for advanced urothelial cancer: high relapse rate and low survival in patients with a complete response.
abstract: OBJECTIVE
  To describe the long-term results of treating patients with advanced urothelial cancer using a combination of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC).
  
  
  METHODS
  Fifty-one patients (37 men and 14 women, median age 66 years, range 41-82) with inoperable or metastatic carcinoma of the bladder, ureter or renal pelvis were treated with M-VAC and their responses evaluated for up to 7 years. Relative dose intensity (RDI) was calculated by dividing the actual dose intensity by the projected total dose intensity and related to outcome. Overall survival was assessed from the date of initiation of treatment with M-VAC, using the Kaplan-Meier method.
  
  
  RESULTS
  Of the 51 patients. 10 (20%) had a complete and 18 (35%) had a partial response, giving an overall response rate of 55% (95% CI, 41-68%). There was no significant difference in the median values of RDIs with response to the M-VAC regimen. The median duration of response was 11.9 months for the 10 patients with a complete response and of these, eight relapsed at a median of 10 months after treatment and died at a median of 8.5 months from the time of disease recurrence. Survival of patients with a complete response differed significantly from those with no response at 1 year after the start of treatment, but not subsequently.
  
  
  CONCLUSIONS
  Long-term follow-up revealed a high relapse rate and poor prognosis in patients with a complete response who received the M-VAC as induction therapy. Therefore, new adjunctive therapies are needed for patients with locally unresectable or metastatic urothelial cancer.
authors.affiliation: Department of Urology, Shimane Medical University, Izumo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Igawa
authors.forename: S
authors.initials: S
authors.lastname: Urakami
authors.forename: H
authors.initials: H
authors.lastname: Shiina
authors.forename: T
authors.initials: T
authors.lastname: Ishibe
authors.forename: H
authors.initials: H
authors.lastname: Kadena
authors.forename: T
authors.initials: T
authors.lastname: Usui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy*; D007682:Kidney Pelvis; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D014516:Ureteral Neoplasms / Q000188:drug therapy*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate