Adjuvant Chemotherapy for Invasive Urothelial Cancer: Experience with a Methotrexate, Vincristin, Cisplatin, Cyclophosphamide, Adriamycin and Bleomycin (MVP-CAB) Regimen: A Preliminary Report

MVP-CAB chemotherapy (methotrexate, vincristine, cisplatin,cyclophosphamide, adriamycin and bleomycin) was administeredto 28 patients with high grade, locally-invasive or regionallymph node- involved urothelial cancer as an adjuvant therapyafter radical surgery. The median follow-up period of all theevaluated patients was 24 (range, 5–62) months. The mediandisease-free durations in patients with pT1b+2+ 3 bladder andupper urothelial cancer were 26 and 22 months, respectively.In contrast, all patients with pT4 disease or lymph node metastaseshad a recurrence within 24 months of surgery. The median disease-freedurations in patients with pure transitional cell carcinoma(grade 3) of the bladder and upper urothelial cancer were 19and 18 months, respectively. The median disease-free durationin patients with grade 3 pT1b+2+3 pure transitional cell carcinomawas 19 months. In contrast, the median disease-free durationin bladder cancer patients with pT1b+2+3 squamous cell carcinomacomponents was 35 months. The three-year actuarial survivalrates were 79 and 89% for pT1b+2+3 bladder and upper urothelialcancer, respectively, while the three-year actuarial survivalrates of patients with pT4 bladder cancer and pT4 upper urothelialcancer were 0 and 100%, respectively. The two-year actuarialsurvivals in the bladder cancer and upper urothelial cancerpatients with lymph node involvement were 0 and 100%, respectively.The three-year actuarial survivals of patients with pure transitionalcell carcinoma (grade 3) were 53 and 80% in bladder cancer andupper urothelial cancer patients, respectively. The three-yearactuarial survival rate in patients with squamous cell carcinomaor adenocarcinoma components which did not recur was, however,100%. Although randomized studies comparing MVP-CAB and M-VAC(methotrexate, vinblastin, adriamycin and cisplatin) or otherchemotherapeutic regimens will be necessary, we believe ourresults indicate that MVP-CAB chemotherapy may be useful asan adjuvant therapy for patients with urothelial cancer, includingthose with squamous cell carcinoma and adenocarcinoma components.More intensive MVP-CAB chemotherapy, i.e., increasing the doseof cisplatin and giving at least five courses, as well as theuse of granulocyte colony stimulating factor and a new antiemeticdrug (granisetron), will, however, be necessary for patientswith pT4 or lymph node-involved disease.