Cisplatin, methotrexate, and vinblastine (CMV): an effective chemotherapy regimen for metastatic transitional cell carcinoma of the urinary tract. A Northern California Oncology Group study.

Harker, W. Graydon; Meyers, Frederick J.; Freiha, Fuad S.; Palmer, John; Shortliffe, Linda D.; Hannigan, John F.; Mcwhirter, K.; Torti, Frank M.

doi:10.1200/jco.1985.3.11.1463

Cited by 333 publications

(71 citation statements)

References 17 publications

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“…Our overall results are remarkably similar to those reported by Harker et al (1985) who first reported the use of CMV chemotherapy for this condition. The results are not as impressive as the M-VAC data from the Memorial Hospital (Stemnberg et al, 1989) but comparisons between different patient populations and treatments are not possible.…”

Section: Toxicitysupporting

confidence: 82%

“…The difficulties in radiological assessment of disease in the pelvis accounted for most of these cases. Other groups have similarly included significant numbers of such patients (Harker et al, 1985;Tannock et al, 1989). We believe that this more accurately reflects the true patient population with advanced TCC.…”

Section: Resultsmentioning

confidence: 99%

“…They reported on the first 60 patients entered into this study in 1985 (Harker et al, 1985) and documented a complete response rate of 28% with an overall median survival of 8 months. In 1983 the Memorial Hospital in New York began treating patients with advanced TCC with M-VAC combination chemotherapy which incorporated four of the most active single agents -methotrexate, vinblastine, doxorubicin and cisplatin.…”

mentioning

confidence: 99%

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CMV chemotherapy for advanced transitional cell carcinoma

Jeffery

Mead²

1992

Br J Cancer

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Between May 1986 and September 1990 a total of 43 patients with metastatic transitional cell carcinoma (TCC) of the urinary tract have been treated at our institution with combination chemotherapy (CMV) consisting of cisplatin 100 mg m-2 i.v. day 2; methotrexate 30 mg m-2 i.v. days 1.8; and vinblastine 4 mg m-2 i.v. days 1.8. Chemotherapy was recycled on day 22 and continued for a maximum of six cycles in responding patients. Of 33 patients with measurable disease 8 (24%) achieved a complete remission (CR). The median survival for patients achieving a CR was 13 months (range 5-29+) whilst the median survival for all 43 patients was 7 months (range 1-29+). Only three patients are still alive--two are disease free. More effective and/or less toxic chemotherapy regimens are needed for the treatment of patients with metastatic TCC.

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Section: Toxicitysupporting

confidence: 82%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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CMV chemotherapy for advanced transitional cell carcinoma

Jeffery

Mead²

1992

Br J Cancer

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“…The median survival for CRs was 11 vs 7 months for PRs (Po0.05) and 6 months for nonresponders. Renal and haematological toxicities with this regimen were moderate (Harker et al, 1985).…”

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confidence: 89%

A phase I/II study of gemcitabine and fractionated cisplatin in an outpatient setting using a 21-day schedule in patients with advanced and metastatic bladder cancer

et al. 2004

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A randomised phase III trial of MVAC (methotrexate, vincristine, doxorubicin, cisplatin) vs gemcitabine and cisplatin (GC) (G 1000 mg m À2 days 1, 8, and 15 plus C 70 mg m À2 day 2, q 4 wks) indicated GC had similar efficacy and lower toxicity (JCO 2000). Significant haematologic toxicities in the GC arm occurred on day 15, necessitating dose adjustments in 37% of cycles. We conducted a phase I/II dose escalation trial using GC on a 21-day cycle, with G and C split between days 1 and 8. The objective of the study to define maximum-tolerated dose and dose-limiting toxicity (DLT), objective response rate, and overall survival. In all, 32 patients with locally advanced, relapsed, or metastatic disease received: dose level 1, G/C 1000/35; level 2, 1100/35; level 3, 1200/35; level 4, 1200/ 45 mg m À2 (G and C given on days 1 and 8 every 3 wks). A total of 19 patients had glomerular filtration rate o60 ml min À1 and 19 patients had metastatic disease. Dose-limiting toxicity was haematologic (grade 4 thrombocytopenia) at dose level 2. Of 151 cycles, at day 15, platelets were o100 in 61 cycles; neutrophils o0.5, platelets o50 in 26 cycles. Only seven cycles were deferred due to haematological toxicity; four for renal toxicity (chemotherapy instituted posthydration). Overall response rate was 65.5% on an intention-to-treat analysis (75% [21/28] for assessable patients), with four complete responses (12.5%) and 17 partial responses (53%). After the median follow-up of 17.2 months (range 13.1 -32.4 months), 12 patients remain alive. The overall median survival was 16 months (range 10.1 -26.6 months). G plus C every 3 weeks is active and well tolerated in an outpatient setting, even in patients receiving prior platinum-based regimens and with poor renal reserve.

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“…In an attempt to improve the results various combinations of DDP and MTX with or without other agents have been studied. Although with combination chemotherapy response rates have increased to 40-70%, the median duration of response and survival is still less than 1 year, whereas such intensive combination chemotherapy is at the cost of considerable toxicity (Oliver et al, 1986;Khandekar et al, 1985;Troner et al, 1987;Hillcoat et al, 1989;Loehrer et al, 1990;Stoter et al, 1987;Harker et al, 1985;Yagoda, 1989;Stemnberg et al, 1989;Logothetis et al, 1990a, b myelosuppression. Other toxicities included skin rash that required early cessation of PTX treatment in two cases, and mild nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

Oral piritrexim, an effective treatment for metastatic urothelial cancer

Wit

Kaye²,

Roberts³

et al. 1993

Br J Cancer

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(Weiss et al., 1989). The relatively short half-life (3 to 5 h) and the lack of polyglutamation of PTX makes a continuous administration of this agent attractive. Consequently, phase I and II studies of PTX were conducted using prolonged, low-dose oral schedules (Feun et al., 1991a,b). Myelosuppression proved to be dose-limiting. Antitumour activity was observed in patients with malignant melanoma and urothelial cancer (Weiss et al., 1989; Feun et al., 1991a,b

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Cisplatin, methotrexate, and vinblastine (CMV): an effective chemotherapy regimen for metastatic transitional cell carcinoma of the urinary tract. A Northern California Oncology Group study.

Cited by 333 publications

References 17 publications

CMV chemotherapy for advanced transitional cell carcinoma

CMV chemotherapy for advanced transitional cell carcinoma

A phase I/II study of gemcitabine and fractionated cisplatin in an outpatient setting using a 21-day schedule in patients with advanced and metastatic bladder cancer

Oral piritrexim, an effective treatment for metastatic urothelial cancer

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