@article{3111864,
    title = "Efficacy of methotrexate/vinblastine/doxorubicin/cisplatin combination in gemcitabine-pretreated patients with advanced urothelial cancer: A retrospective analysis",
    author = "Karadimou, A. and Lianos, E. and Pectasides, D. and Dimopoulos, M.A. and Bamias, A.",
    journal = "Open access journal of urology",
    year = "2010",
    volume = "2",
    number = "1",
    pages = "193-199",
    doi = "10.2147/OAJU.S13122",
    keywords = "carboplatin;  cisplatin;  doxorubicin;  gemcitabine;  methotrexate;  platinum;  vinblastine, adult;  advanced cancer;  aged;  alopecia;  anemia;  article;  cancer combination chemotherapy;  cancer relapse;  cancer staging;  clinical article;  controlled study;  drug efficacy;  drug megadose;  drug response;  drug treatment failure;  female;  follow up;  histology;  human;  human tissue;  kidney disease;  male;  multiple cycle treatment;  nausea and vomiting;  neurotoxicity;  neutropenia;  overall survival;  prediction;  progression free survival;  recurrent cancer;  retrospective study;  stomatitis;  thrombocytopenia;  urogenital tract cancer;  visceral metastasis",
    abstract = "Objective: Second-line treatment options in advanced urothelial cancer are limited. We investigated the efficacy of a methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) combination after failure of gemcitabine/platinum chemotherapy. Patients and methods: Twenty-five patients with advanced urothelial cancer, who received second-line MVAC after first-line gemcitabine/cisplatin (n = 9) or gemcitabine/carboplatin (n = 16), were included in this retrospective analysis. Results: Twenty-two patients (88%) relapsed within 6 months after first-line treatment. Following MVAC, there were 5 (20%) objective responses. Median follow-up was 20.2 months. Median progression-free survival (PFS) was 3.8 months (95% CI: 2.3-5.2), and median overall survival (OS) was 9 months (95% CI: 6.6-11.4). Eastern Cooperative Oncology Group performance status 0.1 versus 2 was associated with longer PFS (5 months versus 3.3 months, P = 0.049). Response or stabilization of disease during second-line chemotherapy predicted for a significantly longer PFS and OS (7.4 versus 3.5, P = 0.005; 15.5 versus 7, P = 0.046). Conclusions: Second-line MVAC chemotherapy may result in prolonged survival in some patients with refractory disease. Further research in this field is necessary. © 2010 Karadimou et al, publisher and licensee Dove Medical Press Ltd."
}