Preliminary Results of M-VAC (Methotrexate, Vinblastine, Doxorubicin and Cisplatin) for Transitional Cell Carcinoma of the Urothelium

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Abstract
The M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) regimen was used to treat 25 patients with transitional cell carcinoma of the urothelial tract. Treatment consisted of mo. cycles fo 30 mg/m2 methotrexate, followed 24 h later by 3 mg/m2 vinblastine, 30 mg/m2 doxorubicin and 70 mg/m2 cisplatin, and concluded with repeat vinblastine and methotrexate on days 15 and 22. Significant tumor regression was noted in 71% of the patients. Complete clinical remission was observed in 12 of 24 patients (50%, 95% confidence limits 30-70%) with bidimensionally measurable indicator lesions, 6 of whom had pathological confirmation. After surgical exploration 4 patients required downstaging to a partial remission. The median duration of response has not yet been reached at 9.5 plus mo., range 4.5 plus - 16 plus. Five patients (21%) had a partial clinical remission of 4-8 plus mo., 1 had a minor response for 4 mo. and 1 had stable disease for 11 mo. All metastatic sites responded, including bone (6 of 8 cases), liver (3 of 5), locoregional (12 of 17) and intravesical (6 of 7) disease. Toxicity included moderately severe myelosuppression that resulted in nadir sepsis in 4 patients and a drug-related death in 1, mild to moderate anorexia, vomiting, alopecia and renal dysfunction. Apparently, treatment with methotrexate, vinblastine, doxorubicin and cisplatin is extremely effective against locoregional and disseminated urothelial tract tumors, with the expectation (95% confidence limits) of inducing objective tumor regression in 53-89% of the cases.