Purpose:
- A high-intensity chemotherapy regimen for muscle-invasive or metastatic urothelial (bladder) cancer.
- Used in neoadjuvant (pre-surgery) or first-line metastatic settings.
Components:
| Drug | Dose | Day |
|---|---|---|
| Methotrexate | 30 mg/m² IV | Day 1 |
| Vinblastine | 3 mg/m² IV | Day 2 |
| Doxorubicin | 30 mg/m² IV | Day 2 |
| Cisplatin | 70 mg/m² IV | Day 2 |
| G-CSF (support) | Starting ~Day 3 (e.g., filgrastim daily or pegfilgrastim once per cycle) | — |
Cycle Frequency: Every 14 days (dose-dense)
- Typical total: 4–6 cycles
Key Differences vs. Standard MVAC:
- Shorter interval (q2w instead of q4w)
- Requires growth factor support (G-CSF)
- Improved efficacy and better tolerability in some studies
Key Toxicities:
| Agent | Major Toxicities |
|---|---|
| Methotrexate | Mucositis, myelosuppression, renal toxicity |
| Vinblastine | Neurotoxicity, myelosuppression |
| Doxorubicin | Cardiotoxicity (cumulative), mucositis, myelosuppression |
| Cisplatin | Nephrotoxicity, ototoxicity, nausea, electrolyte loss |
Supportive Care:
- Aggressive antiemetics (cisplatin = highly emetogenic)
- IV hydration + electrolytes
- G-CSF is mandatory due to neutropenia risk