Modified M-VAC regimen in advanced bladder cancer

Between June 1989 and May 1991, 11 patients with locally advanced and metastatic bladder cancer were treated by modified M-VAC regimen. After four or more courses of neo-adjuvant chemotherapy, the responders underwent to enlarged cystectomy. Patient's age ranged from 37 to 63 years (average 54 years). Four patients had T3NOMO disease, four had T3-4N1–2MO stage and three distant metastases. M-VAC regimen was modified according to the following schedule: MTX 30 mg/M² on days 1 and 15, Vinblastin 3 mg/M² on days 2 and 15, Doxorubicin 30 mg/M² and Cisplatin 80 mg/M² on day 2. Cisplatin infusion was preceded and followed by 2 liters of hydration fluid. Antiemetic regime with Ondansetron and Dexamethasone was instituted. All patients were evaluated for toxicity and response and six underwent 6–18 months of follow-up. 1 patient had significant increase of serum creatinine and, another had acute anemia. We observed 7 PR (65%) and 4 stable disease. In 2 cases of lung and liver localization metastases regressed completely. In 6 cases radical cystectomy was performed only and in 4 cases external beam radiation and cystectomy were performed after the chemotherapy. At 6, 7, 12, 16 months of follow-up 4 patients had no evidence of disease.