Modified MVAC as a Second-Line Treatment for Patients with Metastatic Urothelial Carcinoma after Failure of Gemcitabine and Cisplatin Treatment.
OBJECTIVE
There is no established standard second-line chemotherapy for patients with advanced or metastatic urothelial carcinoma (UC) who failed gemcitabine and cisplatin (GC) chemotherapy. This study was conducted in order to investigate the efficacy and toxicity of modified methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with metastatic UC previously treated with GC.


METHODS
We retrospectively analyzed 28 patients who received modified MVAC between November 2004 and November 2012. All patients failed prior, first-line GC chemotherapy.


RESULTS
The median age of patients was 64.0 years (range, 33.0 to 77.0 years), and 23 (82.1%) patients had an Eastern Cooperative Oncology Group performance status of 0 or 1. The overall response rate and the disease control rate were 36.0% and 64.0%, respectively. After a median follow-up period of 38 weeks (range, 5 to 182 weeks), median progression free survival was 21.0 weeks (95% confidence interval [CI], 6.3 to 35.7 weeks) and median overall survival was 49.0 weeks (95% CI, 18.8 to 79.3 weeks). Grade 3 or 4 hematological toxicities included neutropenia (n=21, 75.0%) and anemia (n=9, 32.1%). Grade 3 or 4 non-hematological toxicities did not occur and there was no treatment-related death.


CONCLUSIONS
Modified MVAC appears to be a safe and active chemotherapy regimen in patients with stable physical status and adequate renal function after GC treatment.
Korea University College of Medicine, Seoul, Korea.
Jung Hyun
JH
Lee
Department of Urology, Korea University College of Medicine, Seoul, Korea.
Sung Gu
SG
Kang
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Seung Tae
ST
Kim
Department of Urology, Korea University College of Medicine, Seoul, Korea.
Seok Ho
SH
Kang
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
In Keun
IK
Choi
Department of Radiation Oncology, Korea University College of Medicine, Seoul, Korea.
Young Je
YJ
Park
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Sang Chul
SC
Oh
Department of Radiology, Korea University College of Medicine, Seoul, Korea.
Deuk Jae
DJ
Sung
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Jae Hong
JH
Seo
Department of Urology, Korea University College of Medicine, Seoul, Korea.
Jun
J
Cheon
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Sang Won
SW
Shin
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Yeul Hong
YH
Kim
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Jun Suk
JS
Kim
Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Kyong Hwa
KH
Park
Cisplatin failure; M-VAC protocol; Second-line; Urothelial carcinoma