M-VECA (METHOTREXATE, VINBLASTINE, EPIDOXORUBICIN AND CARBOPLATIN) INTHE TREATMENT OF ADVANCED UROTHELIAL CARCINOMA

Aims and Background: Urothelial cancer is a chemosensitive disease. Ho wever, cisplatin or anthracycline-containing regimens still provoke se vere toxicity mainly due to reduced renal function and poor performanc e status (PS) of patients. The alm of this study was to verify the pos sibility of substituting carboplatin for cisplatin and epirubicin for doxorubicin in the M-VAC regimen in order to reduce toxicity and impro ve patient tolerance. Methods: Twenty patients with advanced urothelia l tract tumors were treated with a chemotherapeutic regimen composed o f methotrexate (30 mg/mq iv on days 1, 15, 22), vinblastine (3 mg/m2 i v on days 2, 15, 22), epidoxorubicin (35 mg/m2 iv on day 2) and carbop latin (250 mg/m2 iv on day 2) every four weeks (M-VECA). All patients had bidimensionally measurable disease. Results: Of the 18 evaluable p atients, 3 (17%) obtained complete response and 7 (33%) obtained parti al response (50% overall response). The median duration of response wa s 50 weeks (range, 28-88+). Grade III-IV toxicity (leukothrombocytopen ia and mucositis) was observed in 20% of cases. Nevertheless, recovery was prompt in all but 2 patients with poor PS who died of nadir sepsi s. Conclusions: M-VECA was an effective regimen for the treatment of p atients with metastatic urothelial tumors and was safely employed in p atients with a good PS. However, the possibility of substituting.carbo platin for cisplatin as neoadjuvant therapy for less advanced stages n eeds further investigation in randomized studies.