Witjes J A, Wullink M, Oosterhof G O, de Mulder P
Department of Urology, University Hospital, Nijmegen, The Netherlands.
Eur Urol. 1997;31(4):414-9. doi: 10.1159/000474499.
The experience with MVAC (methotrexate, vinblastine, Adriamycin and cisplatin) chemotherapy in advanced urothelial cancer is reviewed with emphasis on toxicity and efficacy.
We report on 28 patients with advanced, progressive transitional cell carcinoma (TCC) of the bladder (27) or ureter (1), treated with MVAC.
The average number of cycles was 4.5. Leucopenia was the most frequent and severe side effect (18% WHO grade I, 46% GII, 19% GII and 4% GIV). Other side effects were acceptable and could be treated successfully. One patient (complete responder) died of a toxic cause (sepsis), a second patient (partial responder) died of an intestinal bleeding (not drug- or cancer-related). Complete response was seen in 10 patients (36%), partial response and stable disease in 4 patients each (14%), progression in 8 patients (29%), and 2 patients were not evaluable for response. However, relapses were frequent (8 of 12 remaining responders, 66%). Median survival of the whole group was 9 months (0-52), without a significant difference for responders and nonresponders (p = 0.29).
Our results are comparable to data from the literature with regard to efficacy and toxicity, although detailed toxicity data are unfortunately not always available.
回顾甲氨蝶呤、长春碱、阿霉素和顺铂（MVAC）化疗晚期尿路上皮癌的经验，重点关注毒性和疗效。
我们报告了28例晚期进展性膀胱（27例）或输尿管（1例）移行细胞癌（TCC）患者接受MVAC治疗的情况。
平均化疗周期数为4.5个。白细胞减少是最常见且严重的副作用（世界卫生组织I级18%，II级46%，III级19%，IV级4%）。其他副作用可接受且能成功治疗。1例（完全缓解者）死于毒性原因（败血症），另1例（部分缓解者）死于肠道出血（与药物或癌症无关）。10例患者（36%）出现完全缓解，4例患者（各14%）出现部分缓解和病情稳定，8例患者（29%）病情进展，2例患者无法评估缓解情况。然而，复发频繁（12例剩余缓解者中的8例，66%）。全组患者的中位生存期为9个月（0 - 52个月），缓解者和未缓解者之间无显著差异（p = 0.29）。
尽管遗憾的是并非总能获得详细的毒性数据，但我们的结果在疗效和毒性方面与文献数据相当。
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