1989 Volume 80 Issue 11 Pages 1644-1650
Total of 37 patients with measurable lesions originating in advanced urothelial cancers received M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) combination chemotherapy and have been followed for a minimum of 12 months.
The study included initial diagnoses of 24 bladder cancers and 13 upper urinary tract cancers in patients whose mean age was 62 years. The patients received a maen of three cycles of M-VAC. Clinical complete remission was observed in five of the 37 patients (13.5%) and partial remission was achieved in 10 patients (27.0%) after mean treatment of 2.4 and 2.1 cycles, respectively, for an over-all objective response rate of 40.5%. The mean duration of response was 11.6±7.1 months and 4.4±3.5 months for complete and partial remissions, respectively.
A mean of 5.2±1.7 cycles of M-VAC was given for complete remissions and 3.5±1.4 cycles in partial remissions. An over-all survival rates after one and two years were 28.125% and 5.859%, respectively. Two of the five patients who had once marked complete remissions died after a mean survival time of 14.5±4.5 months and three survived with a mean duration of 20.3±5.4 months. Meanwhile, all of the piatents who had achieved partial remissions died after a mean survival of 9.1±5.4 months except for one patient who survived more than 12 months.
These results indicate that M-VAC combination chemotherapy for advanced urothelial cancer is extremely efficacious in initial responses. However, significant toxicities necessitated delay or discontinuance of the treatment, and the appearance of strains resistant to these chemotherapeutic agents must be considered in patients who have been repeatedly treated. Therefore, further investigations should be directed toward solution of these problems to improve the long-term results.
