Paz-Ares L, Lianes P, Díaz-Puente M, Rivera F, Passas J, Costas P, Mendiola C, Cortés-Funes H
Medical Oncology Division, 12 de Octubre University Hospital, Madrid, Spain.
Ann Oncol. 1993 Feb;4(2):147-50. doi: 10.1093/oxfordjournals.annonc.a058418.
Despite standard treatment, surgery and/or radiotherapy, most patients with muscle invasive bladder carcinoma die early of distant metastasis. CMV chemotherapy has demonstrated a high response rate with moderate toxicity in advanced bladder carcinoma. In an attempt to eradicate undetectable metastatic disease and to avoid cystectomies, 36 patients were given up-front CMV.
The patients were 34 males and 2 females with a median age of 62 years (45-75); performance status 0-1 (WHO) in 34 patients; histology: 34 transitional carcinomas and 2 anaplastic carcinomas (grade II: 8, grade III: 28). Clinical staging was T2-3a: 19 patients, T3b: 14 patients and T4: 3 patients. Nineteen patients had complete trans-urethral resections (TUR) at diagnosis. The multimodal protocol started with 3 CMV courses (cisplatin 100 mg/m2 i.v. d 1, methotrexate 30 mg/m2 i.v. d 1, 8 and vinblastine 4 mg/m2 i.v. d 1, 8 every 3 weeks). Patients who yielded clinical complete responses (cCR) by cystoscopy, TUR biopsies and imaging techniques were given 3 additional courses. Cystectomy was performed in non-cCR patients and as salvage treatment.
Following 3 CMV cycles, 29 patients (81%) responded (20 cCR and 9 cPR) and 7 (19%) did not (NR). Currently, with a median follow-up of 23.5 months (13-59), 13 have died and 23 are alive, 12 of whom retain their bladders. The projected overall survival is 51% at 4.5 years. Grade 3-4 hematological toxicity was presented in 8% of the cycles. No toxic deaths were observed.
The CMV regimen, after TUR, produces a high response rate with tolerable toxicity. Bladders could be preserved in half of the CR patients.
尽管采用了标准治疗方法，即手术和/或放疗，但大多数肌层浸润性膀胱癌患者仍因远处转移而早期死亡。CMV化疗在晚期膀胱癌中显示出高缓解率和中度毒性。为了根除难以检测到的转移性疾病并避免膀胱切除术，对36例患者进行了一线CMV治疗。
患者中男性34例，女性2例，中位年龄62岁（45 - 75岁）；34例患者的体能状态为0 - 1（WHO）；组织学类型：34例为移行细胞癌，2例为间变性癌（II级：8例，III级：28例）。临床分期为T2 - 3a：19例患者，T3b：14例患者，T4：3例患者。19例患者在诊断时接受了完全经尿道切除术（TUR）。多模式方案开始时进行3个周期的CMV治疗（顺铂100 mg/m²静脉滴注第1天，甲氨蝶呤30 mg/m²静脉滴注第1天、第8天，长春碱4 mg/m²静脉滴注第1天、第8天，每3周一次）。通过膀胱镜检查、TUR活检和影像学技术获得临床完全缓解（cCR）的患者再接受3个周期的治疗。非cCR患者进行膀胱切除术并作为挽救性治疗。
经过3个CMV周期治疗后，29例患者（81%）有反应（20例cCR和9例cPR），7例（19%）无反应（NR）。目前，中位随访23.5个月（13 - 59个月），13例患者死亡，23例存活，其中12例保留了膀胱。预计4.5年时总生存率为51%。8%的周期出现3 - 4级血液学毒性。未观察到毒性死亡。
TUR后采用CMV方案治疗缓解率高，毒性可耐受。一半达到CR的患者可以保留膀胱。
