M-VAC (METHOTREXATE, VINBLASTINE, DOXORUBICIN AND CISPLATIN) FOR ADVANCED TRANSITIONAL CELL-CARCINOMA OF THE UROTHELIUM
M-VAC (METHOTREXATE, VINBLASTINE, DOXORUBICIN AND CISPLATIN) FOR ADVANCED TRANSITIONAL CELL-CARCINOMA OF THE UROTHELIUM
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DOI：
10.1016/s0022-5347(17)42494-3
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发表时间：
1988-03-01
影响因子：
6.6
通讯作者：
WHITMORE, WF
中科院分区：
文献类型：
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作者：
STERNBERG, CN;YAGODA, A;WHITMORE, WF
在接受甲氨蝶呤、长春碱、阿霉素和顺铂治疗的92例患者中，观察到69例完全缓解和部分缓解。83例充分治疗的可测量和可评价的晚期（N+M0和N0M+）移行细胞尿路上皮癌患者中的10%。完全缓解37例。10%的患者临床、病理及手术切除后残留病变。31例完全应答者中有17例（55%）存活了26+至49+个月，估计2年和3年的生存概率分别为71%和55%。部分缓解31例。10%的患者，8%的患者有轻微反应，23%的患者有进展，中位生存期分别为11个月、11个月和7个月。尽管所有转移部位（包括骨和肝脏）均发生反应，但在淋巴结、肺和局部区域病变中观察到的完全肿瘤消退更常见。18%的应答者在6至42个月内发生脑转移，其中一半从未有过全身复发。在其余9例患者中，2例非移行细胞组织学肿瘤患者无缓解，5例（5%）治疗不充分，2例因不可评估的疾病参数而被排除在缓解数据之外，但他们在16+和31+个月时无疾病。毒性是显著的，其中20%的患者经历了最低点败血症，4%的药物相关死亡，31%+1肾毒性和41%+1粘膜炎。新提出的膀胱癌国际反应标准的应用和优点进行了讨论，参考25例患者进行手术重新分期，表明该疾病是分期不足的临床在24%（T小于P），以及参考实现真正的（病理）完全缓解和其他尿路试验。虽然这种疗法似乎对非移行细胞组织学癌症、Tis期疾病和后来的原发性病变的发展具有有限的抗肿瘤活性，但该方案在选定的晚期尿路移行细胞癌患者中有效。
Of 92 patients who received methotrexate, vinblastine, doxorubicin and cisplatin complete and partial remission were observed in 69 .+-. 10 per cent of 83 adequately treated measurable and evaluable patients with advanced stages (N+M0 and N0M+) transitional cell urothelial cancer. Complete remission was achieved in 37 .+-. 10 per cent of the patients clinically, pathologically and after surgical resection of residual disease. With 17 of 31 complete responders (55 per cent) surviving for 26+ to 49+ months, the estimated probability of survival at 2 and 3 years was 71 and 55 per cent, respectively. Partial remission occurred in 31 .+-. 10 per cent of the patients, while 8 per cent had a minor response and 23 per cent had progression with median survivals of 11, 11 and 7 months, respectively. Whereas all metastatic sites responded, including the bone and liver, complete tumor regression was observed more frequently with nodal, pulmonary and local-regional lesions. Brain metastases occurred within 6 to 42 months in 18 per cent of the responders, half of whom never had systemic relapse. Of the remaining 9 patients 2 with nontransitional cell histological tumors did not respond, 5 (5 per cent) were inadequately treated and 2 were excluded from response data because of inevaluable disease parameters but they were free of disease at 16+ and 31+ months. Toxicity was significant, with 20 per cent of the patients experiencing nadir sepsis, 4 per cent a drug-related death, 31 per cent +1 renal toxicity and 41 per cent +1 mucositis. The applications and advantages of the newly proposed international response criteria for bladder cancer are discussed in reference to 25 patients who underwent surgical re-staging, indicating that the disease was understaged clinically in 24 per cent (T less than P), as well as in reference to attainment of true (pathological) complete remission and to other urothelial tract trials. While this therapy seems to have limited antitumor activity against nontransitional cell histological cancer, stage Tis disease and later development of de novo lesions, the regimen is efficacious in selected patients with advanced urothelial tract transitional cell carcinoma.