Korean J Urol.  2007 Dec;48(12):1229-1235. 10.4111/kju.2007.48.12.1229.

The Comparison of the Efficacy and Side Effects between M-VAC and GC Chemotherapy for Advanced or Metastatic Urothelial Carcinoma Patients with a Good Performance Status

Affiliations
  • 1Department of Urology, School of Medicine, Inje University, Busan, Korea. prosdoc@hanmail.net

Abstract

PURPOSE: We wanted to compare the efficacy and toxicity of chemotherapy with methotrexate, vinblastine, adriamycin, cisplatin(M-VAC) versus gemcitabine and cisplatin(GC) for patients with advanced or metastatic urothelial carcinoma.
MATERIALS AND METHODS
Forty-nine patients diagnosed with advanced urothelial cell carcinoma and who were started on chemotherapy were divided into two groups. All of them had a 0-1 Eastern Cooperative Oncology Group performance status. 19 patients received M-VAC chemotherapy and 30 patients received the GC regimen. Among them, the subjects who completed more than 3 cycles of their recommended formula (13/19 for M-VAC, 28/30 for GC) were included in this study. They were evaluated for their overall response rate, the 5-year survival rate, toxicities and the drop-out rate.
RESULTS
The overall response rate and median survival period of the M-VAC and G-C groups were 38%(5/13 cases) and 46%(13/28 cases), and 16.7 months and 43.9 months, respectively. The 5-year survival rates in the two groups were 10% in the M-VAC group and 46% in the G-C treated group(p=0.013). The main hematologic complication was leukopenia and this occurred in 10/19 patients and more than grade 3 leukopenia was noted in 4/10 patients in the M-VAC group and in 19/30 patients and more than grade 3 was noted in 10/19 patients in the GC group.The common non-hematologic side effects between the two groups were nausea/vomiting(84.2% vs 47.7%), alopecia(47.4% vs 26.7%), diarrhea(15.8% vs 16.7%), and nephrotoxicity(15.8% vs 6.7%), respectively. The drop-out rates were 31.6% in the M-VAC group and 6.7% with the GC group.
CONCLUSIONS
For patients with a good performance status with advanced or metastatic urothelial carcinoma, GC chemotherapy is more effective and it has more tolerable toxicities than does the M-VAC regimen.

Keyword

Urothelial carcinoma; Chemotherapy; Efficacy; Toxicity

MeSH Terms

Doxorubicin
Drug Therapy*
Humans
Leukopenia
Methotrexate
Survival Rate
Vinblastine
Doxorubicin
Methotrexate
Vinblastine

Figure

  • Fig. 1 5-year survival graph according to methotrexate, vinblastine, adriamycin, cisplatin (M-VAC) and gemcitabine and cisplatin (GC) chemotherapy.

  • Fig. 2 Overall survival graph according to the cancer site. (A) upper urinary tract, (B) lower urinary tract. GC: gemcitabine and cisplatin, M-VAC: methotrexate, vinblastine, adriamycin and cisplatin.


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