M-Veca (Methotrexate, Vinblastine, Epidoxorubicin and Carboplatin) in the Treatment of Advanced Urothelial Carcinoma

Lorusso, Vito; Berardi, F; Brandi, Mario; Mastria, A; Paradiso, Angelo; Catino, A.; Tatulli, C; Lena, M. De

doi:10.1177/030089169307900306

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Attempts to decrease the marked toxicity of the regimen led to the substitution of carboplatin for cisplatin, substitution of mitoxantrone or epirubicin for Adriamycin, or simply deletion of anthracycline from the regimen [6][7][8]. Attempts to improve upon MVAC by intensifying the doses of therapy delivered not only failed to prolong survival but also increased toxicity in studies done in the United States [9,10].…”

Section: The Role and Limitations Of Mvacmentioning

confidence: 99%

New approaches to treatment of metastatic bladder cancer

Edelman

2000

Curr Oncol Rep

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The combination of methotrexate, vinblastine, Adriamycin, and cisplatin (MVAC) has been the standard therapy for transitional cell carcinoma for over a decade. Despite evidence that MVAC can improve outcome in comparison with single drugs or other combinations in this disease, only a small fraction of patients (less than 4%) become long-term survivors, and the regimen is quite toxic. Attempts to improve upon the MVAC regimen have partially ameliorated its toxicity, but they have not clearly improved outcome. Recently, a number of new chemotherapeutic agents have become available. This report summarizes the current experience with these agents and combinations.

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Section: The Role and Limitations Of Mvacmentioning

confidence: 99%

New approaches to treatment of metastatic bladder cancer

Edelman

2000

Curr Oncol Rep

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“…Unfortu nately, no comparison of toxicity was reported. A recent [44], and doxorubicin [41,43,53]) have been studied. The PMV protocol was used most frequently [30,38,40,48,52], We found reports of 88 patients treated with this pro tocol.…”

Section: Cisplatin Versus Carboplatin Versus Cisplatin/methotrexatementioning

confidence: 99%

“…Some authors [12,19,21,22,43] reported that the highest response rate was obtained in pulmonary metastases, but others considered that the primary tumor responded best [16,23,42]. Adenopathies appeared to respond very poorly.…”

Section: Cisplatin Versus Carboplatin Versus Cisplatin/methotrexatementioning

confidence: 99%

Carboplatin and Urothelial Tumors

et al. 1993

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The prognosis of advanced-stage bladder cancer is poor. Chemotherapy, particularly regimens including platinum salts, appears to increase survival moderately but at the cost of severe, mainly renal toxicity. Platinum is a major factor in this toxicity, and new platinum salts (chiefly carboplatin) have therefore been developed. Carboplatin has no renal toxicity at usual doses, and its use does not require concomitant hyperhydration. Its gastrointestinal, otologic, and general tolerability is excellent. In contrast, most patients develop thrombocytopenia, which can be important, but which is always transitory. The platelet count reaches its nadir (grade 2 or 3) at around day 20, and the leukocyte nadir (grade 2 or 3) occurs about day 19. Anemia is rare. The literature on the use of carboplatin for the treatment of advanced-stage urothelial tumors is reviewed. Carboplatin is used at doses varying between 200 and 400 mg/m², administered in 28-day courses. Dose adjustment is based on serum creatinine level, creatinine clearance, nadir blood cell levels, or previous treatment, reflecting the wide disparity between different studies. Used alone, carboplatin achieved objective responses (ORs) in 14% of patients (3% complete responses, CRs, and 11% partial responses, PRs) in a total group of 327 patients included in 13 trials. In polychemotherapy various combinations of carboplatin with other agents have been reported, most frequently carbopla-tin/methotrexate/vinblastine; the OR rate was 63% (CR rate 19% and PR rate 44%) among 88 patients in four studies. These results confirm the relative efficacy of carboplatin in the treatment of advanced-stage urothelial tumors, particularly when it is combined with other agents. Its efficacy is similar to that of cisplatin, but it is far less toxic. A prospective, comparative trial will be necessary to confirm these data. The pharmacokinetic behaviors of the two platinum salts are markedly different, as carboplatin does not undergo tubular metabolism. The efficacy of carboplatin could be optimized by adapting the dosage to the glomerular filtration rate, which is a more accurate method than extrapolation from the serum creatinine or creatinine clearance values. This has been shown in the case of nonseminomatous germ cell tumors. Calculation of the optimum carboplatin dose should now be applied to urothelial tumors. The general and renal tolerability of a platinum salt is an important element of choice when the efficacies are equivalent. These considerations fully warrant further clinical trials of carboplatin.

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Management of Disseminated Disease in the Patient With Bladder Cancer

Perry

Muss

1994

Urologic Clinics of North America

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M-Veca (Methotrexate, Vinblastine, Epidoxorubicin and Carboplatin) in the Treatment of Advanced Urothelial Carcinoma

Cited by 4 publications

References 9 publications

New approaches to treatment of metastatic bladder cancer

New approaches to treatment of metastatic bladder cancer

Carboplatin and Urothelial Tumors

Management of Disseminated Disease in the Patient With Bladder Cancer

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