Solá C, Mallafré J, Mendoza Solórzano L, Segarra A, Daniels M, Viñolas N, Alcaraz A, Solé M, Alvarez R, Biete A
Bladder Cancer Committee, Clinic Hospital, School of Medicine, Barcelona University, Spain.
Ann Oncol. 1993 Apr;4(4):313-6. doi: 10.1093/oxfordjournals.annonc.a058489.
MVAC is considered the most effective chemotherapy regimen for transitional cell bladder carcinoma. However, due to its significant toxic effects we substituted carboplatin for cisplatin and epirubicin for adriamycin in an attempt to produce the same response with less toxicity.
Twenty-seven patients with invasive transitional cell bladder carcinoma received Carbo-MVE: carboplatin (300 mgr/m2 d2), methotrexate (30 mgr/m2 d1, 15, 22), vinblastine (3 mgr/m2 d2, 15, 22) and epirubicin (30 mgr/m2 d2) every 4 weeks.
There were 2 complete clinical responses (8.4%), 5 partial clinical responses (20.8%), 8 stabilizations (33.3%) and 9 progressions (37.5%). The overall clinical response rate was 29.2% (11%-47.4%, 95% CI), but 2 partial clinical remissions were not pathologically confirmed; were they to be considered as non-responses the response rate would fall even lower (20.8%). Toxicity was moderately severe, with 77.8% developing WHO grade III-IV granulocytopenia, 22.2% grade III-IV thrombocytopenia and 59.3% grade II-III vomiting. There were no toxic deaths nor any renal toxicity.
Our results suggest that Carbo-MVE is less active and at least as hematotoxic as multiagent CDDP-based regimens.
MVAC被认为是治疗移行细胞膀胱癌最有效的化疗方案。然而，由于其显著的毒性作用，我们用卡铂替代顺铂，表柔比星替代阿霉素，以期在降低毒性的同时产生相同的疗效。
27例浸润性移行细胞膀胱癌患者接受了Carbo-MVE方案治疗：每4周给予卡铂（300mg/m²，第2天）、甲氨蝶呤（30mg/m²，第1、15、22天）、长春碱（3mg/m²，第2、15、22天）和表柔比星（30mg/m²，第2天）。
有2例完全临床缓解（8.4%），5例部分临床缓解（20.8%），8例病情稳定（33.3%），9例病情进展（37.5%）。总体临床缓解率为29.2%（11%-47.4%，95%可信区间），但有2例部分临床缓解未得到病理证实；若将其视为未缓解，则缓解率会更低（20.8%）。毒性为中度严重，77.8%的患者发生世界卫生组织III-IV级粒细胞减少，22.2%的患者发生III-IV级血小板减少，59.3%的患者发生II-III级呕吐。无毒性死亡病例，也无肾脏毒性。
我们的结果表明，Carbo-MVE方案的活性较低，且血液毒性至少与基于顺铂的多药方案相当。
