title: Efficacy of methotrexate/vinblastine/doxorubicin cisplatin combination in gemcitabine-pretreated patients with advanced urothelial cancer: a retrospective analysis.
abstract: OBJECTIVE
  Second-line treatment options in advanced urothelial cancer are limited. We investigated the efficacy of a methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) combination after failure of gemcitabine/platinum chemotherapy.
  
  
  METHODS
  Twenty-five patients with advanced urothelial cancer, who received second-line MVAC after first-line gemcitabine/cisplatin (n = 9) or gemcitabine/carboplatin (n = 16), were included in this retrospective analysis.
  
  
  RESULTS
  Twenty-two patients (88%) relapsed within 6 months after first-line treatment. Following MVAC, there were 5 (20%) objective responses. Median follow-up was 20.2 months. Median progression-free survival (PFS) was 3.8 months (95% CI: 2.3-5.2), and median overall survival (OS) was 9 months (95% CI: 6.6-11.4). Eastern Cooperative Oncology Group performance status 0.1 versus 2 was associated with longer PFS (5 months versus 3.3 months, P = 0.049). Response or stabilization of disease during second-line chemotherapy predicted for a significantly longer PFS and OS (7.4 versus 3.5, P = 0.005; 15.5 versus 7, P = 0.046).
  
  
  CONCLUSIONS
  Second-line MVAC chemotherapy may result in prolonged survival in some patients with refractory disease. Further research in this field is necessary.
authors.affiliation: Department of Clinical Therapeutics, University of Athens, Medical School, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Karadimou
authors.forename: Evangelos
authors.initials: E
authors.lastname: Lianos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pectasides
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: Aristotle
authors.initials: A
authors.lastname: Bamias
keywords: MVAC; bladder cancer; second line