M-VAC (METHOTREXATE, VINBLASTINE, DOXORUBICIN AND CISPLATIN) CHEMOTHERAPY FOR TRANSITIONAL CELL-CARCINOMA - THE PRINCESS-MARGARET-HOSPITAL EXPERIENCE
M-VAC (METHOTREXATE, VINBLASTINE, DOXORUBICIN AND CISPLATIN) CHEMOTHERAPY FOR TRANSITIONAL CELL-CARCINOMA - THE PRINCESS-MARGARET-HOSPITAL EXPERIENCE
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DOI：
10.1016/s0022-5347(17)38733-5
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发表时间：
1989-08-01
影响因子：
6.6
通讯作者：
JEWETT, M
中科院分区：
文献类型：
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作者：
TANNOCK, I;GOSPODAROWICZ, M;JEWETT, M
我们用甲氨蝶呤、长春花碱、阿霉素和顺铂联合化疗治疗移行细胞癌41例。患者的平均年龄为56岁。在这些患者中，有33人要么有远处转移，要么有局部区域疾病，无法通过手术或放射治疗治愈。在这些患者中，30人有可测量的疾病，12人有反应(4人完全反应，8人部分反应，应答率40%，95%的可信区间为23%至59%)。这些患者中只有2人在34个月和52个月时仍未维持完全缓解。5例局部晚期膀胱癌放射治疗或膀胱切除术前给予新辅助化疗甲氨蝶呤、长春新碱、阿霉素和顺铂治疗，有效3例，仅1例无病。其余3例患者因复发风险高而接受了术后治疗，均无大碍。该方案的毒性很严重：41%的患者出现中性粒细胞减少的败血症，54%的患者需要住院治疗毒性并发症。3例发生肺栓塞，1例发生深静脉血栓形成。有1例与药物有关的败血症死亡。虽然患者偶尔会从这种化疗中获得长期的好处，但我们的结果建议对该方案的广泛应用持谨慎态度。
We treated 41 patients with transitional cell carcinoma with methotrexate, vinblastine, doxorubicin an cisplatin chemotherapy. Median patient age was 56 years. Of the patients 33 had either distant metastases or locoregional disease that could not be cured by an operation or radiation. Of these patients 30 had measurable disease and 12 responded (4 complete and 8 partial responses, response rate 40 per cent, 95 per cent confidence limits 23 to 59 per cent). Only 2 of these patients remain with an unmaintained complete response at 34 and 52 months. Of 5 patients 3 responded who were treated with neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin for locally advanced bladder cancer before radiation or cystectomy, and only 1 of these patients is free of disease. The remaining 3 patients were treated postoperatively because they were at high risk for recurrence and all are well. Toxicity of the regimen was severe: 41 per cent of the patients experienced neutropenic sepsis and 54 per cent required hospitalization for management of toxic complications. Three patients experienced pulmonary embolism and 1 had deep vein thrombosis. There was a 1 drug-related death of sepsis. Although a patient occasionally may have long-term benefit from this chemotherapy our results suggest caution in the widespread application of this protocol.