Urothelial carcinoma
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Neoadjuvant chemotherapy
MVAC
MVAC: Methotrexate, Vinblastine, A driamycin, Cisplatin
Regimen
- Methotrexate (MTX) 30 mg/m2 IV on days 1, 15, 22
- Vinblastine (Velban) 3 mg/m2 IV on days 2, 15, 22
- Doxorubicin (Adriamycin) 30 mg/m2 IV on day 2
- Cisplatin (Platinol) 70 mg/m2 IV on day 2
28-day cycles x 3 cycles
References
- Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, deVere White RW, Sarosdy MF, Wood DP Jr, Raghavan D, Crawford ED. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003 Aug 28;349(9):859-66. link to original article PubMed
Concurrent chemotherapy & radiation
Cisplatin & RT
Regimen
- Cisplatin (Platinol) 100 mg/m2 IV on days 1 & 22
- Concurrent radiation therapy, total of 39.6 Gy
- If patient is not in complete remission, proceed to cystectomy.
- If patient is in compete remission, treat with an additional:
- Cisplatin (Platinol) 100 mg/m2 IV on day 1
- Concurrent radiation therapy, 25.2 Gy (cumulative dose of 64.8 Gy)
References
- Shipley WU, Winter KA, Kaufman DS, Lee WR, Heney NM, Tester WR, Donnelly BJ, Venner PM, Perez CA, Murray KJ, Doggett RS, True LD. Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03. J Clin Oncol. 1998 Nov;16(11):3576-83. link to original article PubMed
Chemotherapy for metastatic disease
MVAC
MVAC: Methotrexate, Vinblastine, A driamycin, Cisplatin
Regimen
- Methotrexate (MTX) 30 mg/m2 IV on days 1, 15, 22
- Vinblastine (Velban) 3 mg/m2 IV on days 2, 15, 22
- Doxorubicin (Adriamycin) 30 mg/m2 IV on day 2
- Cisplatin (Platinol) 70 mg/m2 IV on day 2
28-day cycles x 6 cycles
References
- Logothetis CJ, Dexeus FH, Finn L, Sella A, Amato RJ, Ayala AG, Kilbourn RG. A prospective randomized trial comparing MVAC and CISCA chemotherapy for patients with metastatic urothelial tumors. J Clin Oncol. 1990 Jun;8(6):1050-5. link to original article PubMed
- Han KS, Joung JY, Kim TS, Jeong IG, Seo HK, Chung J, Lee KH. Methotrexate, vinblastine, doxorubicin and cisplatin combination regimen as salvage chemotherapy for patients with advanced or metastatic transitional cell carcinoma after failure of gemcitabine and cisplatin chemotherapy. Br J Cancer. 2008 Jan 15;98(1):86-90. Epub 2007 Dec 18. link to original article contains protocol PubMed