Modified MVAC as a Second-Line Treatment for Patients with Metastatic Urothelial Carcinoma after Failure of Gemcitabine and Cisplatin Treatment
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PurposeThere is no established standard second-line chemotherapy for patients withadvanced or metastatic urothelial carcinoma (UC) who failed gemcitabine andcisplatin (GC) chemotherapy. This study was conducted in order to investigate theefficacy and toxicity of modified methotrexate, vinblastine, doxorubicin, and cisplatin(MVAC) in patients with metastatic UC previously treated with GC. Materials and MethodsWe retrospectively analyzed 28 patients who received modified MVAC betweenNovember 2004 and November 2012. All patients failed prior, first-line GC chemotherapy. ResultsThe 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 of0 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], 6.3to 35.7 weeks) and median overall survival was 49.0 weeks (95% CI, 18.8 to 79.3weeks). 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 occurand there was no treatment-related death. ConclusionModified MVAC appears to be a safe and active chemotherapy regimen in patientswith stable physical status and adequate renal function after GC treatment.
Abstract
PurposeThere is no established standard second-line chemotherapy for patients withadvanced or metastatic urothelial carcinoma (UC) who failed gemcitabine andcisplatin (GC) chemotherapy. This study was conducted in order to investigate theefficacy and toxicity of modified methotrexate, vinblastine, doxorubicin, and cisplatin(MVAC) in patients with metastatic UC previously treated with GC. Materials and MethodsWe retrospectively analyzed 28 patients who received modified MVAC betweenNovember 2004 and November 2012. All patients failed prior, first-line GC chemotherapy. ResultsThe 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 of0 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], 6.3to 35.7 weeks) and median overall survival was 49.0 weeks (95% CI, 18.8 to 79.3weeks). 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 occurand there was no treatment-related death. ConclusionModified MVAC appears to be a safe and active chemotherapy regimen in patientswith stable physical status and adequate renal function after GC treatment.
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