BACKGROUND:Gemcitabine plus cisplatinum was shown to exert comparable activity and a different toxicity profile when compared to the methotrexate, vinblastine, doxorubicin, cisplatinum (MVAC) regimen in patients with advanced bladder cancer.
Accelerated MVAC (aMVAC, the four drugs being administered every 2weeks with granulocyte colony-stimulating factor (G-CSF)) is better tolerated than conventional MVAC, with a trend for improved activity. There is no standard of care after failure of gemcitabine-platinum (GP) chemotherapy. Our aim was to assess the activity and toxicity of accelerated MVAC as second-line treatment.
METHODS: We reviewed data from patients previously treated with GP who had received aMVAC at two institutions at the time of disease progression.
RESULTS: Forty-five patients received aMVAC after GP: 18 (40%) and 27 (60%) had received GP in the adjuvant and the metastatic settings, respectively. The median time to progression (TTP) after first-line GP was 9.3months. The response rate for aMVAC was 61%, including 4/38 (10%) complete responses. Median time to progression and median overall survival (OS) were 5.8 and 14.2months, respectively. Median TTP and OS were 9.6 and 16.5months when GP was used in the adjuvant setting and 4.4 and 5.7months when GP was used in the metastatic setting. Grade 3-4 toxicities were observed in 31 patients (69%), including four sepsis-related deaths.
CONCLUSION: aMVAC exerts clinical activity after previous treatment with GP, especially when GP was used in the adjuvant setting. aMVAC should however be administered with caution due to toxicity.
Written by:
Edeline J, Loriot Y, Culine S, Massard C, Albiges L, Blesius A, Escudier B, Fizazi K. Are you the author?
Institut Gustave Roussy, Department of Cancer Medicine, University of Paris Sud, Villejuif, France; Centre Eugène Marquis, Department of Medical Oncology, Rennes, France.
Reference: Eur J Cancer. 2012 Feb 22. Epub ahead of print.
doi: 10.1016/j.ejca.2012.01.022
PubMed Abstract
PMID: 22364733
