According to results published in an early on-line version from the Journal of Clinical Oncology, the chemotherapy regimen referred to as MVAC appears superior to the chemotherapy regimen DC for the treatment of advanced bladder cancer. However, MVAC is associated with significantly more severe side effects than DC.
Bladder cancer is a common cancer, with approximately 55,000 new cases diagnosed in the United States each year. The bladder is a muscular organ located in the lower abdomen that serves to store urine. Ninety percent of bladder cancers originate in the inner lining of the bladder, which is composed of specific cells called transitional cells. This type of cancer is called transitional cell carcinoma (TCC). Treatment options for TCC depend on a number of factors, including the location and extent of cancer, and may include surgery, radiation, chemotherapy and/or biologic therapy (treatment utilizing the body’s immune system to fight cancer). Metastatic TCC means that the cancer has spread from the site of origin to different sites throughout the body, often invading vital organs, and is often too widespread to benefit from surgery. Combination chemotherapy is commonly used to treat advanced TCC. Researchers continue to evaluate new chemotherapy combinations in order to improve duration of survival and quality of life in patients with advanced bladder cancer.
The chemotherapy combination consisting of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) is one standard treatment regimen for advanced bladder cancer. However, other chemotherapy combinations, such as another standard treatment option consisting of Gemzar® and Platinol® (cisplatin), have demonstrated comparable outcomes, with fewer side effects than MVAC. Taxotere® (docetaxel)-containing regimens have also demonstrated significant anti-cancer activity in the treatment of bladder cancer, and have been associated with fewer side effects than MVAC. Thus, researchers conducted a clinical trial to directly compare MVAC to the chemotherapy combination Taxotere® and Platinol® (DC) in the treatment of advanced bladder cancer.
This trial involved 220 patients with metastatic or inoperable bladder cancer; half of whom were treated with MVAC and the other half of whom were treated with DC, and their outcomes were directly compared. All patients were also treated with therapy to prevent low levels of white blood cells (neutropenia). Anti-cancer response rates were 54% for patients treated with MVAC, compared with 37.4% for those treated with DC. The average time to cancer progression was 9.4 months for patients treated with MVAC, compared with 6.1 months for those treated with DC. Overall survival was 14.2 months for the group of patients treated with MVAC, compared with 9.3 months for those treated with DC. However, MVAC was associated with significantly more severe side effects, including neutropenia (35% in the MVAC group versus 19% in the DC group), low levels of platelets (thrombocytopenia) (5.7% in the MVAC group versus 0.9% in the DC group), and systemic (full-body) infection due to neutropenia (11.6% in the MVAC group versus 3.8% in the DC group).
The researchers concluded that MVAC appears superior to DC in the treatment of metastatic or inoperable bladder cancer. However, MVAC is associated with significant side effects, so other Taxotere®– and/or Gemzar®-containing regimens are continuing to be evaluated in the treatment of bladder cancer so that outcomes may be improved upon and side effects reduced. Patients with advanced bladder cancer may wish to speak with their physician about the risks and benefits of participating in a clinical trial evaluating different chemotherapy combinations or other novel therapeutic approaches. Sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov).
Reference: Bamias A, Aravantinos G, Deliveliotis C, et al. Docetaxel and cisplatin with granulocyte colony-stimulating factor (G-CSF) versus MVAC with G-CSF in advanced urothelial carcinoma: a multicenter, randomized, phase III study from the Hellenic Cooperative Oncology Group.
Journal of Clinical Oncology. 2003;24: early on-line release.