Abstract
Background: Despite recent progress in surgical treatment, patients with locally advanced bladder cancer are at significant risk for postoperative disease recurrence. Therefore, several investigators have evaluated the usefulness of adjuvant chemotherapy for such patients; however, the efficacy of adjuvant chemotherapy for patients with locally advanced bladder cancer remains unclear. The objective of this study was to determine the long-term effects and toxicity of a novel multidrug chemotherapy, the MVP-CAB regimen as an adjuvant chemotherapy following radical cystectomy.
Patients and methods: Between January 1994 and December 2000, 38 patients with pathologically confirmed locally advanced bladder cancer (i.e. pT3< and/or pN1 or pN2) received at least three cycles of MVP-CAB therapy in an adjuvant setting, consisting of methotrexate, vincristine, cisplatin, cyclophosphamide, adriamycin and bleomycin. Clinical outcomes of these patients were retrospectively analyzed to evaluate the usefulness of adjuvant MVP-CAB therapy following radical cystectomy.
Results: After a median follow-up of 63 months (range 3–110 months), 18 patients (47.4%) were alive without evidence of disease-recurrence, while 16 (42.1%) died of recurrent disease, and 4 (10.5%) died of other disease. The 1, 3 and 5-year cause-specific survival rates were 81.6, 57.8 and 57.8%, respectively. There were significant differences in cause-specific survival according to pathological stage (pT3≥ vs. pT4) and lymph node metastasis (pN0 vs. pN1 or pN2), while age, gender, tumor grade, microvascular invasion, histological subtype and concomitant carcinoma in situ were not associated with cause-specific survival. Furthermore, among these factors, pathological stage and lymph node metastasis could be used as independent predictors of cause-specific survival on multivariate analysis. In this series, there was good compliance with the MVP-CAB regimen, and toxicity was tolerable.
Conclusion: These findings suggest that despite the necessity of performing randomized study, MVP-CAB may have an effect similar to that of other cisplatin-based combination chemotherapy regimens, such as M-VAC regimen, but with comparatively mild toxicity.