title: Toxicity and results of MVAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy in advanced urothelial carcinoma.
abstract: OBJECTIVE
  The experience with MVAC (methotrexate, vinblastine, Adriamycin and cisplatin) chemotherapy in advanced urothelial cancer is reviewed with emphasis on toxicity and efficacy.
  
  
  METHODS
  We report on 28 patients with advanced, progressive transitional cell carcinoma (TCC) of the bladder (27) or ureter (1), treated with MVAC.
  
  
  RESULTS
  The average number of cycles was 4.5. Leucopenia was the most frequent and severe side effect (18% WHO grade I, 46% GII, 19% GII and 4% GIV). Other side effects were acceptable and could be treated successfully. One patient (complete responder) died of a toxic cause (sepsis), a second patient (partial responder) died of an intestinal bleeding (not drug- or cancer-related). Complete response was seen in 10 patients (36%), partial response and stable disease in 4 patients each (14%), progression in 8 patients (29%), and 2 patients were not evaluable for response. However, relapses were frequent (8 of 12 remaining responders, 66%). Median survival of the whole group was 9 months (0-52), without a significant difference for responders and nonresponders (p = 0.29).
  
  
  CONCLUSIONS
  Our results are comparable to data from the literature with regard to efficacy and toxicity, although detailed toxicity data are unfortunately not always available.
authors.affiliation: Department of Urology, University Hospital, Nijmegen, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Witjes
authors.forename: M
authors.initials: M
authors.lastname: Wullink
authors.forename: G O
authors.initials: GO
authors.lastname: Oosterhof
authors.forename: P
authors.initials: P
authors.lastname: de Mulder
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality; D002945:Cisplatin / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D014523:Urethral Neoplasms / Q000188:drug therapy* / Q000401:mortality; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014747:Vinblastine / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate