Neoadjuvant M-VAC (Methotrexate, Vinblastine, Adriamycin and Cisplatin) Effect on the Invasive Bladder Tumor

Oh, Ju Hyun; Ryu, Soo Bang

Abstract

We evaluated the effect of M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy in 63 patients with invasive transitional cell carcinoma of the bladder between January 1987 and December 1993. The patients consisted of 59 male and 4 female. Patient age ranged from 35 to 80 years with a mean of 61.5 years. All patients were given 1-7 cycles(mean 2.7 cycles) of M-VAC chemotherapy and followed for 1 to 8 years. Ten patients(16%) achieved a clinical complete remission(CR), 22(35%) partial remission(PR), 11(17.5%) minor response(MR), 11(17.5%) stabilization(STAB), and 9(14%) progression(PROG). The overall clinical response rate was 51%. Of 22 patients who underwent surgery(radical cystectomy in 15, partial cystectomy in 7), 3 patients(14%) achieved objective pathologic response. The estimated 5-year survival rate according to response of primary tumor to chemotherapy was 86%, 55% in patients with response and non-response, respectively. This difference between the groups was statistically significant(P<0.05). Overall 3-years and 5-years survival rates were 73% and 71%, respectively, and mean survival was 3.1 years. The toxicity of the regimen was generally acceptable, but 79% of the patients experienced myelosuppression, 8% hepatic toxicity and 6% stomatitis. In conclusion, the patients who achieved a clinical response seem to have a better prognosis and neoadjuvant M-VAC chemotherapy may result in bladder preservation for selected patients with muscle invasive bladder cancer.