MVAC is the name of a chemotherapy combination that includes: 

  • methotrexate
  • vinblastine
  • doxorubicin (Adriamycin)
  • cisplatin

MVAC is a treatment for bladder cancer. It is often used to try to stop bladder cancer from coming back after surgery. This is called adjuvant therapy. 

Sometimes it is also used to shrink the cancer before surgery or radiotherapy. This is known as neoadjuvant therapy. You may also have it for bladder cancer that has spread to other parts of the body.  

How MVAC works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have MVAC

You have all drugs into your bloodstream (intravenously), usually through a long plastic tube that goes into a large vein in your chest.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have MVAC

You usually have these drugs as cycles of treatment. Each cycle takes either 2 or 4 weeks. When you have MVAC over 2 weeks it is called accelerated MVAC. 

Usually, you have between 3 to 6 cycles of MVAC or 3 to 6 cycles of accelerated MVAC.  

If you have it over 2 weeks (accelerated MVAC)

Day 1
  • You have methotrexate as an injection into your bloodstream.
Day 2
  • You have vinblastine as a drip into your bloodstream.
  • You have doxorubicin as a drip into your bloodstream.
  • You have cisplatin as a drip into your bloodstream.
Day 3 to 14
  • You have no treatment.

You then start a new cycle of treatment.

After chemotherapy you may also have a drug called GCSF. You have it as injections under the skin. GCSF encourages the bone marrow (where the blood cells are made) to make more white blood cells. 

If you have it over 4 weeks

Day 1
  • You have methotrexate as an injection into your bloodstream.
Day 2
  • You have vinblastine as a drip into your bloodstream.
  • You have doxorubicin as a drip into your bloodstream.
  • You have cisplatin as a drip into your bloodstream.
Day 3 to day 14
  • You have no treatment
Day 15
  • You have methotrexate as an injection into your bloodstream.
  • You have vinblastine as a drip into your bloodstream.
Day 16 to day 21
  • You have no treatment.
Day 22
  • You have methotrexate as an injection into your bloodstream.
  • You have vinblastine as a drip into your bloodstream.
Day 23 to day 28
  • You have no treatment

Then you start a new cycle of treatment. 


You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 


You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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 petechiae).

Tiredness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Kidney damage

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

A sore mouth 

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges, lemons and grapefruits and chew gum to keep the mouth moist. Tell your doctor or nurse if you have ulcers.

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Red or pink urine

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

Hearing loss

You might have some hearing loss, especially with high pitched sounds. Tell your doctor or nurse if you notice any changes.

Skin sensitivity to sunlight

Don’t use sunbeds or sit in the sun. Cover up or use a sun block if you go out in the sun. Remember to put sun cream on your head or wear a hat if you have lost any hair there.

Watery eyes

Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). Tell your doctor or nurse if this is a problem for you. They can prescribe medicines to help. Try to avoid dust, pollen or animal hairs as they can make the watering worse. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include

  • redness, swelling or leaking at your drip site
  • an allergic reaction while having this treatment
  • dry, flaky, red and sore skin in areas where you have had radiotherapy in the past
  • loss of appetite
  • metallic taste in your mouth
  • nail changes such as darker nails
  • high temperature (fever) and chills
  • blurred vision and eye pain
  • liver changes that are very mild and unlikely to cause symptoms
  • numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons
  • a ringing sound in your ears (tinnitus) that usually gets better on its own once the treatment ends

Rare side effects

This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

  • depression
  • headaches
  • changes to the heart muscle that are usually temporary
  • jaw pain
  • high blood pressure that can cause headaches, nose bleeds, blurred or double vision or shortness of breath
  • fast heart rate
  • difficulty emptying your bladder
  • dizziness
  • a severe infection
  • sore eyes

Coping with side effects

We have more information about side effects and tips on how to cope with them.

Important information

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

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


Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.


Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

This page is due for review. We will update this as soon as possible.

Related links