Adverse events of MVAC chemotherapy in patients with advanced urothelial cancer of the bladder

Abstract

There have only been a few reports about adverse events of methotrexate, vinblastine, adriamycin and cisplatin (MVAC) chemotherapy under supportive care with granulocyte stimulating factor (G-CSF) and 5-hydroxytryptamine 3 receptor (5-HT3R) antagonists. The purpose of this study was to retrospectively review the adverse events of the chemotherapy. We analyzed 59 patients with advanced bladder cancer who received MVAC chemotherapy at Sapporo Medical University hospital from January 1992 to September 2004. The adverse events were evaluated according to the Common Terminology Criteria for Adverse Events version 3.0 (Japanese edition). Thirty-one of the 59 patients (52.6%) received MVAC in the neoadjuvant setting. Two courses of chemotherapy were most frequently used in the neoadjuvant and adjuvant settings, and treatment of metastatic or recurrent lesions. More than 90% of patients experienced hematological adverse events such as some grade of leukocytopenia and neutropenia in each course of the chemotherapy. Grade 3 or 4 neutropenia was seen in 60-75% of patients. Grade 3 or 4 leukopenia and/or neutropenia in the first course of the chemotherapy was associated with patients with impaired renal function (60 mL/min< or = creatinine clearance <80 mL/min). Febrile neutropenia was found in 6 patients (5.0%), including one who died of subsequent septic shock and adult respiratory distress syndrome. Nausea was seen in 70-80% of patients. MVAC chemotherapy for advanced bladder cancer was performed with tolerable adverse events. The current results provide relevant information mainly for those who need 2 courses of chemotherapy in the neoadjuvant or adjuvant setting.

MVAC療法の副作用について, G-CSF, 5-HT3受容体拮抗剤使用下での報告は多くない。今回, われわれはMVAC療法の副作用について検討した。1992年1月から2004年9月までに札幌医科大学附属病院にてMVAC療法を施行した進行性膀胱尿路上皮癌59例について検討した。副作用の評価は有害事象共通用語基準v3.0日本語訳に従って行った。59人中31例(52.6%)がMVACをneoadjuvant療法として受けていた。Neoadjuvant療法, adjuvant療法, 転移または局所再発に対する治療として2コースが最も多く施行されていた。それぞれのコースにおいて, 90%以上の症例で白血球減少, 好中球減少などの血液毒性が認められた。Grade 3または4の好中球減少は60～75%に認められた。1コース目におけるGrade 3または4の白血球減少, 好中球減少に関しては, 腎機能障害で有意な関連が認められた。発熱性好中球減少は6例(5.0%)に認められ, そのうちの1例が敗血症性ショック, 成人呼吸促迫症候群にて死亡した。非血液毒性としては, 嘔気が70～80%に認められた。進行性膀胱尿路上皮癌に対するMVAC療法の副作用は許容できる範囲であった。今回の結果は, 特に, neoadjuvant療法, adjuvant療法として2コースを行う際に有用な情報であると思われた。(著者抄録)