CMV front-line chemotherapy in transitional bladder carcinoma

BACKGROUND: Despite standard treatment, surgery and/or radiotherapy, mostpatients with muscle invasive bladder carcinoma die early ofdistant metastasis. CMV chemotherapy has demonstrated a highresponse rate with moderate toxicity in advanced bladder carcinoma.In an attempt to eradicate undetectable metastatic disease andto avoid cystectomies, 36 patients were given up-front CMV MATERIALS AND METHODS: The patients were 34 males and 2 females with a median age of62 years (45–75); performance status 0–1 (WHO) in34 patients; histology: 34 transitional carcinomas and 2 anaplasticcarcinomas (grade II: 8, grade III: 28). Clinical staging wasT_2-3a: 19 patients, T_3b: 14 patients and T₄: 3 patients. Nineteenpatients had complete trans-urethral resections (TUR) at diagnosis. The multimodal protocol started with 3 CMV courses (cisplatin100 mg/m2 i.v. d 1, methotrexate 30 mg/m2 i.v. d 1, 8 and vinblastine4 mg/m² i.v. d 1, 8 every 3 weeks). Patients who yielded clinicalcomplete responses (cCR) by cystoscopy, TUR biopsies and imagingtechniques were given 3 additional courses. Cystectomy was performedin non-cCR patients and as salvage treatment. RESULTS: Following 3 CMV cycles, 29 patients (81%) responded (20 cCRand 9 cPR) and 7 (19%) did not (NR). Currently, with a medianfollow-up of 23.5 months (13–59), 13 have died and 23are alive, 12 of whom retain their bladders. The projected overallsurvival is 51% at 4.5 years. Grade 3–4 hematologicaltoxicity was presented in 8% of the cycles. No toxic deathswere observed. CONCLUSION: The CMV regimen, after TUR, produces a high response rate withtolerable toxicity. Bladders could be preserved in half of theCR patients. bladder carcinoma, bladder preservation, neo-adjuvant chemotherapy, CMV regimen