title: Possible survival benefit of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin combination therapy (HD-MVAC) over conventional MVAC in metastatic urothelial carcinoma patients.
abstract: Eight patients with metastatic urothelial carcinoma received high-dose (HD)-MVAC therapy, which consisted of methotrexate (30 mg/m2) on day 1, vinblastine (3 mg/m2) on day 2, doxorubicin (30 mg/m2) on day 2 and cisplatin (70 mg/m2) on day 2 (14-day cycle). Patients were treated with granulocyte colony-stimulating factor (G-CSF) (100 microg) subcutaneously from day 4 to 10. For comparison, 7 patients with metastatic urothelial carcinoma who received conventional (C)-MVAC (28-day cycle) were enrolled in this study. Overall survival in the HD-MVAC group was significantly better than that in the C-MVAC group (p = 0.012, log rank test). The overall response rate for measurable metastatic lesions was similar in both groups (HD-MVAC, 62.5% vs. C-MVAC, 57.1%, p =0.622). The patients in the HD-MVAC group were able to receive significantly more courses than the C-MVAC group (HD-MVAC, median 3 courses vs. C-MVAC, 2 courses, p=0.045, Student's t test). The frequency of grade 3/4 toxicities was not statistically different between the 2 groups. HD-MVAC therapy rather than C-MVAC therapy may be advocated as a first-line chemotherapy for metastatic patients, since HD-MVAC is associated with a shorter period required for each course, a lower frequency of dose reduction and a possible benefit in terms of overall survival.
authors.affiliation: The Department of Urology, Akita University School of Medicine.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inoue
authors.forename: Takashi
authors.initials: T
authors.lastname: Obara
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Saito
authors.forename: Teruaki
authors.initials: T
authors.lastname: Kumazawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.forename: Shinobu
authors.initials: S
authors.lastname: Matuura
authors.forename: Norihiko
authors.initials: N
authors.lastname: Tsuchiya
authors.forename: Shigeru
authors.initials: S
authors.lastname: Satoh
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000633:toxicity; D002945:Cisplatin / Q000008:administration & dosage / Q000633:toxicity; D004317:Doxorubicin / Q000008:administration & dosage / Q000633:toxicity; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000633:toxicity; D008875:Middle Aged; D009362:Neoplasm Metastasis; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000401:mortality; D019459:Urothelium; D014747:Vinblastine / Q000008:administration & dosage / Q000633:toxicity
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate