dd-MVAC as neoadjuvant chemotherapy for muscle-invasive bladder cancer: a single-center study

Aim. To evaluate the efficacy, safety, and feasibility of dd-MVAC (methotrexate, vinblastine, doxorubicin, cyclophosphamide) chemotherapy in real-world clinical practice.

Materials and methods. Patients were enrolled between September 2022 and May 2025. They were scheduled to receive six cycles of neoadjuvant dd-MVAC chemotherapy, supported by granulocyte colony-stimulating factor from day 4 to day 9 of each cycle, repeated every two weeks. Eligible patients had urothelial bladder cancer staged as cT2–4a, N0–3, M0, with creatinine clearance of ≥50 mL/min. The primary endpoint was the pathological complete response (pCR) rate. Secondary endpoints included toxicity, the number of treatment cycles completed, and pathological response.

Results. The study included 40 patients. Of these, 87 % (n = 35) completed six cycles of dd-MVAC, while 8 % (n = 3) and 5 % (n = 2) completed five and four cycles, respectively. Full protocol drug doses were administered to 57 % of patients (n = 23), while a 15 % dose reduction was required in 43 % (n = 17). The majority of these dose reductions (59 %, n = 10) were implemented after the fifth cycle. The most frequent grade 3 adverse events (per Common Terminology Criteria for Adverse Events (CTCAE) v.5.0) were hematological: neutropenia in 40 % (n = 16), anemia in 10 % (n = 4), and thrombocytopenia in 10 % (n = 4). One fatal case of febrile neutropenia occurred. The most common grade 1–2 adverse event was asthenia reported in 80 % (n = 32) of patients. Surgical treatment was performed in 80 % (n = 32) of the cohort. Cystectomy was conducted in 91 % (n = 29) of these surgical patients, while organ-preserving surgery was performed in 9 % (n = 3). A complete pathological response (ypT0pN0) was achieved in 53 % (n = 17) of surgically treated patients, and downstaging to n = 3). Disease stabilization was reported in the remaining 38 % (n = 12). No significant decline in renal function was observed; median glomerular filtration rate was 80.4 mL/min/1.73 m² pre-treatment and 89.1 mL/min/1.73 m² post-treatment.

Conclusion. The dd-MVAC regimen is an effective and feasible neoadjuvant therapy for muscle-invasive bladder cancer, enabling the majority of patients to complete the full preoperative course of chemotherapy.