Abstract
Purpose: We wanted to compare the efficacy and toxicity of chemotherapy with methotrexate, vinblastine, adriamycin, cisplatin (M-VAC) versus gemcitabine and cisplatin (GC) for patients with advanced or metastatic urothelial carcinoma. Materials and Methods: Forty-nine patients diagnosed with advanced urothelial cell carcinoma and who were started on chemotherapy were divided into two groups. All of them had a 0-1 Eastern Cooperative Oncology Group performance status. 19 patients received M-VAC chemotherapy and 30 patients received the GC regimen. Among them, the subjects who completed more than 3 cycles of their recommended formula (13/19 for M-VAC, 28/30 for GC) were included in this study. They were evaluated for their overall response rate, the 5-year survival rate, toxicities and the drop-out rate. Results: The overall response rate and median survival period of the M-VAC and G-C groups were 38% (5/13 cases) and 46% (13/28 cases), and 16.7 months and 43.9 months, respectively. The 5-year survival rates in the two groups were 10% in the M-VAC group and 46% in the G-C treated group (p=0.013). The main hematologic complication was leukopenia and this occurred in 10/19 patients and more than grade 3 leukopenia was noted in 4/10 patients in the M-VAC group and in 19/30 patients and more than grade 3 was noted in 10/19 patients in the GC group. The common non-hematologic side effects between the two groups were nausea/vomiting (84.2% vs 47.7%), alopecia (47.4% vs 26.7%), diarrhea (15.8% vs 16.7%), and nephrotoxicity (15.8% vs 6.7%), respectively. The drop-out rates were 31.6% in the M-VAC group and 6.7% with the GC group. Conclusions: For patients with a good performance status with advanced or metastatic urothelial carcinoma, GC chemotherapy is more effective and it has more tolerable toxicities than does the M-VAC regimen. (Korean J Urol 2007;48:1229-1235)
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