COMBINATION CHEMOTHERAPY WITH METHOTREXATE, VINCRISTINE, CISPLATINUM, CYCLOPHOSPHAMIDE, ADRIAMYCIN, AND BLEOMYCIN (MVP-CAB) FOR METASTATIC UROTHELIAL CANCER

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  • 尿路上皮腫瘍転移例に対する METHOTREXATE, VINCRISTINE, CISPLATINUM, CYCLOPHOSPHAMIDE, ADRIAMYCIN, BLEOMYCIN 併用療法MVP-CAB療法

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Abstract

We studied 31 patients with bidimensionally measurable metastases of urothelial cancer who were treated with a planned regimen (20mg/m2 methotrexate, 0.6mg/m2 vincristine, 500mg/m2 cyclophosphamide, 20mg/m2 adriamycin, and 30mg bleomycin on day 1, and 50mg/m2 cisplatinum on day 2) in cycles given every 3 weeks. CR was achieved in 4 patients (13%) and PR in 17 patients (55%). The response rates according to the disease characteristics were 71% for TCC, 33% for SCC, 67% for renal pelvis tumors, 67% for bladder tumors, 73% for lung metastases, 67% for liver metastases, and 67% for lymph node metastases. The median response duration and the number of cycles of therapy were 32 months/3 cycles for patients with a CR and 6 months/6 cycles for those with a PR. The median duration of survival was 32 months (range: 3-46) in CR, 11 months (range: 1-37) in PR, and 6 months (range: 2-10) in non responders (NC+PD). A significant prolongation of survival was noted in patients with either CR (p<0.01) or PR (p<0.05). Then main toxic effects were pulmonary fibrosis and myelosuppression. Two patients aged 73 and 81 died of pulmonary fibrosis. However, it was possible to prevent pulmonary fibrosis by not administering bleomycin to patients over 70 years of age, or to patients with pulmonary dysfunction. WBC count nadirs of <2, 000/m3 were noted in 22 patients (71%). Platelet count nadirs of <5×104/mm3 were noted in 7 patients (23%). However, there were no deaths due to myelosuppression.

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