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Bladder cancer

Accelerating MVAC

Nature Reviews Urology volume 11, page 307 (2014)Cite this article

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To address concerns relating to delayed cystectomy and toxicity with neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) therapy, Plimack et al. and Choueiri et al. have evaluated an accelerated, dose-dense regimen (AMVAC), in which the cycle time was halved, doubling the dose intensity of doxorubicin and cisplatin. Growth factor support was also used to avoid neutropenia-related toxicity.

In each study, approximately 40 patients with cT2–T4N0–N1 muscle-invasive bladder cancer completed 3–4 treatment cycles, around 50% of whom were downstaged to non-muscle-invasive disease (≤T1M0N0) at surgery. Only 12 patients across both studies experienced grade 3–4 adverse events, and the median time to surgery was shorter than previously reported for standard MVAC. “These studies show that AMVAC can achieve pathological responses similar to 12-week regimens, but in a shorter timeframe,” states Plimack. “Shortening the time required to administer chemotherapy is important as patients are able to take less time off work, and in patients who do not respond to chemotherapy, definitive surgery is not excessively delayed,” she explains.

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References

  1. Choueiri, T. K. et al. J. Clin. Oncol. 10.1200/JCO.2013.52.4785

  2. Plimack, E. R. et al. J. Clin. Oncol. 10.1200/JCO.2013.53.2465

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  1. David Killock
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Killock, D. Accelerating MVAC. Nat Rev Urol 11, 307 (2014). https://doi.org/10.1038/nrurol.2014.128

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