Feasibility and safety of accelerated MVAC (aMVAC) in geriatric patients with muscle-invasive bladder cancer.

Authors

Sai Prasath, Deepak Sundriyal, S P Harsha, Anusha Mruthyunjaya Swamy, Karthik Jayalingappa, Mayank Kapoor, Mahesh Koulagi, Vikas Kumar Panwar, Ankur Mittal, Amit Sehrawat

Published in

Medical oncology (Northwood, London, England). Volume 43. Issue 9. Aug 20, 2026. Epub Aug 20, 2026.

Abstract

Dose-dense MVAC (ddMVAC) is a standard regimen for muscle-invasive bladder cancer (MIBC), but tolerability concerns often limit its use in geriatric patients. Accelerated MVAC (aMVAC), delivered as a single-day regimen, may reduce hospital visits and resource use. This study assessed the feasibility and safety of aMVAC in geriatric patients with MIBC in a real-world, resource-constrained setting. We included patients aged 60 years or older with histologically confirmed MIBC (stages II-IV). Eligible patients received three or four cycles of single-day aMVAC (methotrexate 30 mg/m², vinblastine 3 mg/m², doxorubicin 30 mg/m², cisplatin 70 mg/m²) every 14 days, with growth factor support. Feasibility was defined as completing 3 or 4 cycles within the protocol-defined duration. Toxicities were graded per CTCAE v5.0. Among 33 geriatric patients, 30 (90.9%) completed ≥ 3 cycles, and 28 (84.8%) completed four cycles within the planned timeframe. Dose reductions for grade 3 or higher toxicities were required in 10 (30.3%) patients, and treatment discontinuation occurred in 3 (9%). Grade 3 hematologic events occurred in 12% and non-hematologic events in 33.3%; the most common were anemia, mucositis, and fatigue. No grade 4 toxicities, febrile neutropenia, or treatment-related deaths were observed. Pathological complete response (pCR; ypT0N0) was achieved in 8 (36.4%) patients, and 12 (54.5%) patients had pathologic down-staging compared with their clinical stage. aMVAC is a feasible regimen for geriatric patients with MIBC, achieving high treatment completion rates and acceptable toxicity. The simplified one-day protocol reduces hospital stay and logistical burden while maintaining therapeutic intensity. aMVAC represents a practical and feasible alternative in real-world, resource-limited settings.Clinical Trial RegistrationThe trial was registered under clinical trial registry of India : CTRI/2021/10/037450.

PMID:
42622897
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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