Bladder Cancer Stage 2A: Choosing Between MVAC, GP, or TP Chemotherapy?

Q: Bladder Cancer Stage 2A: Choosing Between MVAC, GP, or TP Chemotherapy?

Mawan： For the postoperative adjuvant chemotherapy of bladder cancer, current data still supports MVAC as the standard regimen. <br>If there are concerns about toxicity, GP can be chosen as an alternative. <br>TP has higher toxicity as well, so it is recommended to consider its u

For stage 2A bladder cancer with lymph node involvement, the recommended chemotherapy regimen is typically MVAC (Methotrexate, Vinblastine, Doxorubicin, and Cisplatin). However, the choice between MVAC and Gemcitabine plus Cisplatin (GC) may depend on the patient's overall health, preferences, and specific clinical circumstances. It is essential to discuss the options with an oncologist to determine the most appropriate treatment plan?

Dear Dr.
Fan,
In February, my elderly family member experienced hematuria, and in March, bladder cancer was diagnosed.
They were immediately transferred to Ho Shin Hospital, where the doctor indicated that it could be stage II to IV.
Subsequently, they underwent tumor resection and radical cystectomy (with creation of a neobladder).
After the surgery, the doctor mentioned that although it was stage II, one cancer cell was found in the removed lymph nodes.
Therefore, we were advised to proceed with "adjuvant chemotherapy." Last week, they were referred from urology to oncology, where the doctor recommended the MVAC regimen (Methotrexate, Vinblastine, Doxorubicin, and Cisplatin) consisting of six cycles (with one week of treatment followed by one week of rest for each cycle), which is intended to suppress the cancer cells (with an expected duration of effect of about one year).

After researching online, I discovered that due to the high toxicity and significant side effects of MVAC, many patients struggle to tolerate it.
Currently, many hospitals are recommending GP (Gemcitabine and Cisplatin) or TP (Paclitaxel and Cisplatin) instead.
My family member is scheduled to have Part-A installed this Thursday and will be admitted for chemotherapy next Thursday.
Given the patient's current condition, do you have any recommendations regarding the chemotherapy regimen (MVAC, GP, TP, or others)?
P.S.
I have considered seeking a "second opinion," but my family member is uncertain and worried about changing hospitals for chemotherapy (they are not fond of changes).

mawan, 30~39 year old female. Ask Date: 2009/06/02

Dr. Fan Sheng reply Oncology

Mawan: For the postoperative adjuvant chemotherapy of bladder cancer, current data still supports MVAC as the standard regimen.
If there are concerns about toxicity, GP can be chosen as an alternative.
TP has higher toxicity as well, so it is recommended to consider its use only if there is an unfortunate recurrence.

Reply Date: 2009/06/02

More Info

When considering chemotherapy options for a patient diagnosed with Stage 2A bladder cancer, the choice between MVAC (Methotrexate, Vinblastine, Doxorubicin, and Cisplatin), GP (Gemcitabine and Cisplatin), or TP (Paclitaxel and Cisplatin) is crucial and should be tailored to the individual patient's health status, cancer characteristics, and personal preferences.

Overview of Chemotherapy Regimens
1. MVAC: This regimen is considered a standard treatment for muscle-invasive bladder cancer. It has been shown to be effective in reducing tumor burden and improving survival rates. However, MVAC is associated with significant toxicity, including myelosuppression, nausea, vomiting, and potential for severe infections. The treatment typically consists of six cycles, with each cycle lasting about four weeks. Given the potential side effects, it is essential to monitor the patient's blood counts and overall health closely during treatment.

2. GP: This regimen is often preferred for patients who may not tolerate the toxicity of MVAC. Gemcitabine and Cisplatin have a more favorable side effect profile compared to MVAC. GP has been shown to be effective in treating bladder cancer, particularly in patients with a good performance status. The regimen is generally better tolerated, making it a suitable option for older patients or those with comorbidities.

3. TP: This combination also involves Cisplatin but pairs it with Paclitaxel. While it can be effective, TP may also carry a risk of significant side effects, including neuropathy and myelosuppression. It is generally considered when other options are not suitable or when there is a specific indication for its use.

Considerations for Treatment Choice
- Patient's Health Status: The patient's age, overall health, and any pre-existing conditions should be taken into account. Older patients or those with comorbidities may benefit more from GP due to its lower toxicity profile.

- Cancer Characteristics: The presence of cancer cells in the lymph nodes after surgery indicates a higher risk of recurrence, which may necessitate a more aggressive approach. However, the potential side effects of MVAC must be weighed against its benefits.

- Patient Preference: Engaging the patient and their family in the decision-making process is vital. If the patient is apprehensive about the side effects of MVAC, discussing the option of GP or TP may provide a more comfortable path forward.

Seeking a Second Opinion
It is understandable to consider seeking a second opinion, especially when facing a significant treatment decision. A second opinion can provide reassurance and may offer additional insights into the best treatment options available. If the patient is hesitant to change hospitals, it may be possible to consult another oncologist within the same healthcare system or through telemedicine.

Conclusion
In summary, for a patient with Stage 2A bladder cancer who has undergone surgery and has lymph node involvement, the choice between MVAC, GP, or TP should be made collaboratively, considering the patient's health status, cancer characteristics, and personal preferences. While MVAC is a standard regimen, GP may offer a safer alternative with a favorable side effect profile. Engaging in a thorough discussion with the oncology team and considering a second opinion can help ensure the best possible treatment plan is chosen.

Similar Q&A

Understanding Ureteral Cancer: Treatment Options and Patient Concerns

Hello Dr. Lai: My mother was diagnosed with stage III ureteral malignant tumor in April of this year. She has undergone the removal of her left kidney, ureter, and a portion of the bladder. She is now preparing to undergo chemotherapy. I would like to ask: 1. Are there only two c...

Dr. Lai Yicheng reply Oncology
Dear Ms. Wu, 1. You have been diagnosed with urothelial carcinoma, and the standard treatment involves a chemotherapy regimen of Gemcitabine and Cisplatin, which is the first-line therapy and the most effective option available. 2. The medical center also utilizes this standard ...

Post-Surgery Treatment Options for Bladder Cancer: What to Consider

Hello Dr. Du, I have undergone a complete cystectomy for bladder cancer, and during my follow-up visit, the doctor suggested that immunotherapy would be a safer option. However, the cost is as high as 2 million NTD, and it's not a one-time treatment, which poses a significan...

Dr. Du Shixi reply Urology
Hello: After surgery, the hospital usually informs you of the stage of the disease, which helps to understand the approximate survival rate associated with that stage of treatment. You can discuss this with your physician. Currently, the use of immunotherapy statistically can ext...

Understanding the Pros and Cons of Chemotherapy for Superficial Bladder Cancer

Hello Dr. Lai: I would like to ask about a superficial and small bladder urothelial carcinoma that was removed via endoscopic electrosurgery (today, June 16). The physician recommended chemotherapy as a better option. My concern is that injecting medication through the urethra wo...

Dr. Lai Ronghao reply Urology
Dear Miss Anna, regarding your inquiry, it is best to consult your attending physician, as providing answers without understanding the patient's condition may lead to incorrect information. Intravesical chemotherapy does not indiscriminately kill both good and bad cells; its...

Choosing Between Injectable and Oral Chemotherapy for Post-Gastric Cancer Surgery

Hello Dr. Chen! My mother underwent surgery to remove most of her stomach due to gastric cancer on March 3rd. She is now facing the decision of whether to receive chemotherapy through injections or oral medication. The primary physician and the referred oncologist both advocate f...

Dr. Chen Yunfang reply Oncology
Hello: 1. Currently, only TS-1 has been used for one year in "postoperative stage III gastric cancer," which shows clearer benefits (the pharmaceutical company is willing to invest in research costs because it is a patented drug). The older drug Ufur, which has a simila...