Why It's Called the MVAC Regimen

• Methotrexate

• Vinblastine

• Adriamycin (doxorubicin)

• Cisplatin

Purpose of the MVAC Regimen

• Advanced bladder cancer

• Urothelial carcinoma, including metastatic bladder cancer or metastatic transitional cell carcinoma of the ureter or renal pelvis

• It is used as adjuvant chemotherapy (after cystectomy) or neoadjuvant chemotherapy (before and after cystectomy) for advanced bladder cancer stages T3–4 N1–3.

Key Components

1. Methotrexate: a chemotherapy agent that inhibits the metabolism of folic acid, thereby preventing DNA synthesis and cell reproduction.

2. Vinblastine: an alkaloid that interferes with microtubule formation in the spindle apparatus, hindering mitotic and metabolic processes.

3. Adriamycin (Doxorubicin): an anthracycline antibiotic that intercalates DNA and inhibits topoisomerase II, inducing DNA breaks.

4. Cisplatin: a platinum-containing chemotherapeutic drug that forms DNA adducts, leading to apoptosis.

Administration

• Methotrexate: Administered at 30 mg/m² on days 1, 15, and 22.

• Vinblastine: Administered at 3 mg/m² on days 2, 15, and 22.

• Doxorubicin (Adriamycin): Administered at 30 mg/m² on day 2.

• Cisplatin: Administered at 70 mg/m² on day 2.

• Folinic acid is also used as a supportive measure on days 2, 16, and 23 to mitigate the side effects of methotrexate.

Clinical Pearls

• Hematologic Monitoring: Regular monitoring of blood counts is crucial due to the potential for severe myelosuppression.

• Hydration and Diuresis: Ensuring adequate hydration and diuretic use to prevent nephrotoxicity associated with cisplatin.

• Anti-emetic Use: Incorporate aggressive anti-emetic strategies before and after administration to manage nausea and vomiting, particularly with cisplatin and doxorubicin.

• Mucositis Prevention: Regular oral care and possibly prophylactic ice chips during methotrexate administration can help reduce the risk of mucositis.

• Infection Prophylaxis: Use prophylactic antibiotics if indicated, and teach patients the signs of infection for early detection.

Patient Management Tips

• Patient Education: Educate patients about the signs of complications such as infection, neuropathy, and gastrointestinal disturbances.

• Supportive Care: Provide access to nutritional support, pain management, and psychological support services.

• Side Effect Management: Be proactive in managing side effects like neutropenia, nephrotoxicity, and thrombocytopenia with appropriate medications and interventions.

• Regular Assessments: Schedule regular assessments to monitor patient response to therapy, adjust doses as needed, and manage side effects effectively.

• Encourage Reporting of Symptoms: Encourage patients to report symptoms early, particularly those related to cisplatin-induced neurotoxicity and gastrointestinal issues.

References