title: 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.
  
  
  CONCLUSIONS
  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.affiliation: Institut Gustave Roussy, Department of Cancer Medicine, University of Paris Sud, 39 rue Camille Desmoulins, Villejuif, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Edeline
authors.forename: Yohann
authors.initials: Y
authors.lastname: Loriot
authors.forename: Stephane
authors.initials: S
authors.lastname: Culine
authors.forename: Christophe
authors.initials: C
authors.lastname: Massard
authors.forename: Laurence
authors.initials: L
authors.lastname: Albiges
authors.forename: Aurore
authors.initials: A
authors.lastname: Blesius
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine