Which combination regimens are used in the treatment of metastatic bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

First-line, platinum-based combinations are active in locally advanced and metastatic urothelial carcinoma. However, long-term outcomes, including disease-specific and overall survival, remain suboptimal.

Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) is a standard combination regimen for treatment of metastatic bladder cancer. MVAC has an objective response rate of 57-70% and a complete response rate of 15-20%. Median overall patient survival with this regimen is typically 13- 15 months, and the 2-year survival rate is 15-20%. [128, 129, 130]

Gemcitabine and cisplatin (GC) is a newer regimen that has been shown to be as effective as MVAC but with less toxicity. [131] In particular, less nephrotoxicity is seen with GC than with MVAC. [132] GC is now considered a first-line treatment for bladder cancer. Unfortunately, about 40-50% of patients with advanced urothelial carcinoma have coexisting medical issues that preclude the use of cisplatin-based therapy.


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