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This page tells you about the chemotherapy combination MVAC and its possible side effects. There are sections about


What MVAC is

MVAC is the name of a chemotherapy combination made up of the following drugs

  • M – Methotrexate
  • V –  Vinblastine
  • A – Doxorubicin (Adriamycin)
  • C – Cisplatin

You can click on the links above to find out about the side effects of each individual drug. 

MVAC is a treatment for bladder cancer. It is most often used to try to stop bladder cancer from coming back after surgery. This is known as adjuvant therapy. Sometimes it is used to shrink the cancer before surgery or radiotherapy. This is known as neoadjuvant therapy. 

There are a number of combinations of drugs for bladder cancer. MVAC is just one type of treatment. Your doctor will take into account your stage and grade of bladder cancer and your general health to decide on the best treatment for you.


How you have MVAC

MVAC drugs are liquids. You have them into your bloodstream (intravenously). You may have a thin, short tube (cannula) put into a vein in your arm on the day of each treatment. Or you may have the drugs through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. The tube stays in place as long as you need it.

You usually have this chemotherapy as cycles of treatment. Each cycle takes either 2 weeks or 4 weeks. When you have MVAC over two weeks it is called Accelerated MVAC.

If you have MVAC over 2 weeks, on day one you usually have methotrexate, vinblastine, doxorubicin and cisplatin. After this you have no more chemotherapy for 13 days. This completes a cycle of your treatment. After the chemotherapy, you may also have injections of a drug called GCSF under the skin. GCSF encourages the bone marrow (where blood cells are made) to make more white blood cells.

If you have MVAC over 4 weeks, you may have all the drugs on day one or over two days. You then have 2 more doses of methotrexate and vinblastine again somewhere between 1 week and 3 weeks later. This completes a cycle of your treatment.

Usually, you have between 3 and 6 cycles of MVAC.

We have listed the side effects associated with MVAC below. You can use the links to find out more about each side effect. Where there is no link please see our cancer drugs side effects section or use the search box at the top of the page.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Hair loss affects almost everyone treated with MVAC and includes all head and body hair. It usually begins 2 to 5 weeks after the treatment starts but will grow back after the treatment ends
  • Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your kidneys are working. It is important to drink plenty of fluids
  • You may not be able to hear some high pitched sounds after your treatment but this usually gets better after a while
  • Feeling or being sick is usually well controlled with anti sickness medicines
  • A sore mouth
  • Your urine may become a pink or red colour for one or two days after treatment but this won't harm you
  • Sensitivity of the skin to sunlight – don’t sit out in the sun, and do cover up or use sun block on exposed skin
  • Watery eyes happen in about 1 out of 4 people (25%) and may last for several days after the beginning of each treatment
  • Women may stop having periods (amenorrhoea) but this may only be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your nurse straight away
  • Some people have an allergic reaction while having MVAC treatment, usually at the first or second treatment. Let your treatment team know immediately if you have skin rashes, itching, or you feel hot and shivery. Also tell them if you go red in the face, feel dizzy, or have a headache, shortness of breath, anxiety, or a sudden need to pass urine
  • Reddening of the skin in areas where you have had radiotherapy in the past. The skin may get dry and flaky and feel sore and hot. This goes away on its own but keep affected areas out of the sun
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or lasts more than 3 or 4 days
  • Constipation – your nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
  • Loss of appetite
  • A metallic taste in your mouth
  • Nails may darken or develop white lines
  • A high temperature (fever) and chills
  • Blurred vision or eye pain
  • Liver changes that are very mild and unlikely to cause symptoms. Your liver will almost certainly go back to normal when treatment finishes. You will have regular blood tests to check how well your liver is working
  • Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons. This starts within a few days or weeks and usually goes within a few months of finishing treatment. For some people it may be permanent
  • Ringing in the ears (tinnitus) affects some people but nearly always gets better on its own

Rare side effects

Fewer than 1 in 100 people have these.

  • Sore eyes
  • Depression
  • Headaches
  • Damage to heart muscle from doxorubicin, which is usually temporary but for a small number of people may be permanent. Your doctor will check your heart before and after your treatment
  • Jaw pain
  • High blood pressure
  • A fast heart rate
  • Difficulty emptying your bladder
  • Dizziness
  • About 1 or 2 people in 100 (1 to 2%) die due to the side effects of MVAC chemotherapy. This is usually due to infection from the effects of the treatment on bone marrow. This has to be weighed up against the benefit to you in treating your cancer

Important points to remember

You may have a few of the above side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

These drugs may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not breastfeed during this treatment because the drugs may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information


More information about MVAC

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information about these drugs look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 23 December 2014