Bladder Cancer (cont.)
Kevin C. Zorn, MD, FRCSC, FACS
Gagan Gautam, MD, MCh
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
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What is chemotherapy for bladder cancer?
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Patients who are diagnosed with metastatic bladder cancer (M stage - M1; cancer which has spread to other parts of the body) are usually treated with chemotherapy. Chemotherapy may also be used in cases of "locally advanced" bladder cancer (T stage - T3 and above and/or N stage - N1 and above) in an attempt to decrease the chances of the cancer coming back after radical cystectomy. This is known as "adjuvant chemotherapy." Another strategy entails administering "neoadjuvant chemotherapy" by giving these medications before radical cystectomy in an attempt to improve the results of surgery and decrease the size of the tumor.
It has been shown that chemotherapy has the potential to control metastatic bladder cancer and increase the chances of cure when used in a neoadjuvant or adjuvant setting along with surgery. However, chemotherapy has its own set of side effects and may not be tolerated by all individuals.
The time-honored chemotherapy regimen for bladder cancer is called the MVAC. It is a combination of four medications given in cyclical form.
Oncologists currently prescribe MVAC in a "dose dense" fashion. This means the patient takes the drugs more frequently than was previously the accepted treatment schedule, as well as taking growth factors to help the blood counts to recover faster from the effects of the chemotherapy drugs.The older schedule for MVAX therapy is no longer recommended according to the National Comprehensive Cancer Network.
Some patients with heart disease may not be in a condition to receive Adriamycin and may receive CMV instead (CMV = MVAC - Adriamycin)
An alternative regimen is a combination of gemcitabine (Gemzar) and cisplatin. This is increasingly being used nowadays since some studies have shown that it is equally effective as the MVAC regime with fewer side effects.
Cisplatin, which is the main medication in all these regimens, cannot be given to patients who have an abnormal kidney function. In this case, it may be substituted by carboplatin (Paraplatin), which, however, is not as effective as cisplatin-based chemotherapy. Carboplatin-containing regimens are not recommended in place of those containing cisplastin to render the drug cocktail more effective.
Medically Reviewed by a Doctor on 11/26/2013
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