CMV

CMV is the name of a chemotherapy combination used to treat bladder cancer. It is made up of the drugs

• C = Cisplatin
• M = Methotrexate
• V = Vinblastine

Click on the links to find out about the side effects for each individual drug. There are a few different combinations of drugs for bladder cancer. CMV is just one type of treatment. Your doctor will decide which combination is best to treat your type of bladder cancer and stage of bladder cancer.

CMV drugs are liquids. You have them into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them 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. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have CMV as cycles of treatment. Each cycle lasts 3 weeks. You usually have 4 cycles over 3 months.

Sometimes you have all the chemotherapy drugs on the first day and can then go home. You then have all the drugs again 3 weeks later.

In another way of giving CMV you visit the hospital twice during each cycle of treatment. On the first visit, you need to stay in hospital overnight. You have vinblastine and methotrexate on the first day and the next day you have cisplatin. You go back to hospital a week later and have another dose of methotrexate and vinblastine as an outpatient. You then have a 2 week break before the next cycle begins.

We have listed the side effects associated with CMV below. The side effects of a combination of drugs are usually a mixture of the side effects of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. Use the links to find out more about each side effect. For more information where there is no link please see our cancer drugs side effects section or click on search at the top of the page.

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

A temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment team if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Hair loss or hair thinning may start about 3 to 4 weeks after your treatment begins – this is temporary and your hair will grow back after the treatment ends
• Kidney damage – you will have blood tests before treatment to make sure your kidneys are able to cope with the treatment. Your nurse will ask you to drink plenty of water and give you fluids through your drip before and after your treatment to help flush out your kidneys
• You may not be able to hear some high pitched sounds after treatment – this usually gets better on its own but for some people may be permanent
• Feeling or being sick – you will have anti sickness injections or tablets but about 5 out of 10 people (50%) still feel sick a few hours after each treatment. It sometimes lasts for a few days and if it is not controlled, tell your doctor or nurse
• A sore mouth and mouth ulcers
• CMV may have a harmful effect on a developing baby so it is not advisable to become pregnant or father a child if you are having this treatment – talk about contraception with your doctor or nurse
• Women may stop having periods (amenorrhoea) – this may only be temporary but can be permanent
• Loss of fertility – you may not be able to get pregnant or father a child after treatment with these drugs. It is important to talk to your doctor about your fertility before starting treatment

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 chemotherapy nurse immediately
• Allergic reactions can sometimes happen when the chemotherapy is going into your bloodstream – tell your nurse if you have skin rashes and itching, feel hot and shivery, go red in the face, feel dizzy, have a headache, and feel breathless, anxious or suddenly need to pass urine
• Diarrhoea – drink plenty of fluids and tell your doctor or nurse if it becomes severe or lasts more than 3 or 4 days
• Constipation is usually prevented with laxatives, which your nurse can give you – if you are constipated for more than 3 days, tell your doctor or nurse
• Loss of appetite
• Gritty, painful eyes
• Blurred vision
• Skin changes, such as darkening, lightening or an itchy rash
• Skin sensitivity to sunlight – use a high factor sun cream and cover up when you go out
• Coughing or breathlessness due to inflammation of the lungs
• Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment finishes but you will have regular blood tests to check how well your liver is working
• Loss of taste or a metallic taste in your mouth
• Numbness or tingling 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. Some people may get permanent numbness
• Ringing in the ears (tinnitus) that nearly always gets better on its own

Fewer than 1 in 100 people have these.

• Depression
• Headaches
• Jaw pain
• High blood pressure
• A faster heart rate
• Difficulty emptying your bladder
• Dizziness

Some other medicines such as aspirin, some antibiotics, non steroidal anti inflammatory drugs and some vitamins may interfere with the way methotrexate works. They can increase the side effects. Always tell your doctor about any other medicines, vitamins, herbal supplements, over the counter remedies, or health supplements you are taking.

The side effects above 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

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your nurse will give you a contact number to ring for advice or reassurance if you have any questions or problems.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.