MVAC

MVAC is the name of a chemotherapy combination used to treat 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.

MVAC is made up of the drugs

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

You can click on the links to find out about the side effects of each individual drug. The side effects of a combination of drugs are usually a mixture of the effects of each drug. The combination may increase or decrease your chance of getting each side effect. Or it may change the severity.

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 find the best treatment for you.

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 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 this chemotherapy as cycles of treatment. Each cycle takes 4 weeks. There are different ways of having the treatment. You have all the drugs on the first or second day of your treatment cycle. Then you have 2 more doses of methotrexate and vincristine somewhere between the 8th and 22nd day of the cycle. Usually, you have between 4 and 6 cycles of MVAC, which takes 4 to 6 months.

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.

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

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

• 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 doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• 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, but 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 drugs
• A sore mouth
• Your urine may become a pink or red colour for one or two days after treatment
• Sensitivity of the skin to sunlight – don’t sit out in the sun, and 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
• MVAC may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Women may stop having periods (amenorrhoea) but this may only be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you

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
• 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 any skin rashes, itching, feeling hot, shivering, going red in the face, feeling dizzy, 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, and 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 if diarrhoea becomes severe or lasts more than 3 or 4 days
• Constipation – your doctor may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• Loss of appetite
• Metallic taste in your mouth
• Nails may darken or develop white lines
• Fever and chills
• Blurred vision or eye pain
• 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
• 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 but for some people may be permanent
• Ringing in the ears (tinnitus) affects some people, but nearly always gets better on its own
• 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

Fewer than 1 in 100 people have these.

• Sore eyes
• Depression
• Headaches
• Jaw pain
• High blood pressure
• Fast heart rate
• Difficulty emptying your bladder
• Dizziness and changes in your vision
• About 1 or 2 people in 100 (1 to 2%) die due to the side effects of MVAC chemotherapy – 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

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 chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

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

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 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 from your chemotherapy.

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.