M-VAC Chemotherapy in Metastatic Transitional Cell Carcinoma of the Bladder: Long Term Results / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Recent studies have shown the benefits of the use of methotrexate, vinblastine, doxorubicin and cisplatin(M-VAC) in the treatment of advanced transitional cell carcinoma of the bladder. Although the overall and complete response rates and survival is improved from the use of M-VAC, more than 90% of the patients with metastatic disease still die of the disease, with a median survival of approximately 1 year. MATERIALS AND METHODS: To evaulate the long-term results of M-VAC chemotherapy, we reviewed 51 patients with advanced transitional cell carcinoma of the bladder who were treated with standard dose M-VAC(30mg/m2 methotrexate on day 1, 15, and 22, 3mg/m2 vinblastine on day 3, 15, and 22, 30mg/m2 doxorubicin on day 3 and 70mg/m2 cisplatin on day 2). There were 43 men and 8 women. The age of the patients ranged from 31 to 74 years(mean 60.8) and the duration of follow up ranged from 2.4 to 79.5 months(mean 23.8). RESULTS: Of the 51 patients, 10(19.6%) had a complete and 15(29.4%) had a partial response, giving an overall response rate of 49%. The median duration of response was 11.2 months for the 10 patients with a complete response and of these, eight relapsed at a median of 10.4 months after complete response. Survival of patients with a complete response differed significantly from those with no response at 1 year after the start of treatment, but not subsequently. Toxicity included moderated to severe myelosuppression that resulted in sepsis in 2 patients and mild to moderate anorexia, vomiting, alopecia and renal dysfunction. CONCLUSIONS: Long-term follow up revealed a high relapse rate and poor prognosis in patients with a complete response who received the M-VAC as induction therapy. Therefore, more effective new adjunctive regimens are needed for patients with locally unresectable or metastatic transitional cell carcinoma.