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MVAC: Chemotherapy for Bladder Cancer

MVAC is an acronym and stands for a combination chemotherapy treatment for advanced bladder cancer: methotrexate (M), vinblastine (V), Adriamycin (A) (= doxorubicin) and cisplatin (C).

Indications for MVAC Chemotherapy

• Metastatic bladder cancer or metastatic transitional cell carcinoma of ureter or renal pelvis
• Adjuvant chemotherapy (after cystectomy) or neoadjuvant chemotherapy (before and after cystectomy) for advanced bladder cancer (T3–4 N1–3).

Since the combination chemotherapy treatment with Cisplatin-Gemcitabine is less toxic, MVAC is the second choice chemotherapy for bladder cancer (Von der Maase et al., 2000).

Dosage of MVAC Chemotherapy

One cycle of MVAC lasts 28 days. If well tolerated, metastases are treated with 6 cycles. Adjuvant or neoadjuvant treatment with MVAC is usually done with 4 cycles. Treatment of MVAC should be stopped due to progressive toxicity or due to progressive disease under treatment.

• Methotrexate: 30 mg/m², days 1, 15, 22
• Vinblastine: 3 mg/m², days 2, 15, 22
• Adriamycin (= Doxorubicin): 30 mg/m², day 2
• Cisplatin: 70 mg/m², day 2
• Pegfilgrastim 6 mg s.c. on day 4
• Consider Folinic acid 4 × 15 mg q6h on days 2, 16, 23 in patients with a higher toxicity risk.

Dosisdichtes MVAC (ddMVAC)

Dose-dense MVAC is a high-intensity MVAC protocol delivered every 2 weeks with G-CSF support. In the neoadjuvant setting for muscle-invasive bladder cancer, ddMVAC achieves higher pathological response rates and improved 3-year progression-free survival compared with gemcitabine/cisplatin (GC), as shown in the VESPER trial, but at the cost of greater acute toxicity and without a clearly demonstrated overall survival advantage (Pfister et al., 2021). ddMVAC is an option for fit, cisplatin-eligible patients, in whom maximal tumor downstaging is desired pre-cystectomy.

References

Pfister C, Gravis G, Flechon A: 652O Dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC) as perioperative chemotherapy for patients with muscle-invasive bladder cancer (MIBC): Results of the GETUG/AFU VESPER V05 phase III trial. Annals of Oncology 2021.

Von der Maase, H.; Hansen, S. W.; Roberts, J. T.; Dogliotti, L.; Oliver, T.; Moore, M. J.; Bodrogi, I.; Albers, P.; Knuth, A.; Lippert, C. M.; Kerbrat, P.; Sanchez Rovira, P.; Wersall, P.; Cleall, S. P.; Roychowdhury, D. F.; Tomlin, I.; Visseren-Grul, C. M. & Conte, P. F. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study
J Clin Oncol, 2000, 18, 3068-77

  Deutsche Version: MVAC Chemotherapie des fortgeschrittenen Harnblasenkarzinoms

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