MVAC is the name of a chemotherapy combination that includes: 

  • M - methotrexate
  • V - vinblastine
  • A - doxorubicin (Adriamycin)
  • C - cisplatin

It is a treatment for bladder cancer. You might have MVAC:

  • to try to stop bladder cancer from coming back after surgery. This is called adjuvant therapy
  • before surgery or radiotherapy to shrink the cancer. This is known as neoadjuvant therapy
  • for bladder cancer that has spread to other parts of the body (advanced or metastatic bladder cancer) 

How does MVAC work?

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

How do you have MVAC?

You have all drugs into your bloodstream (intravenously). 

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. You have a new cannula each time you have treatment.

How often do you have MVAC?

You usually have these drugs as cycles of treatment Open a glossary item. 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 accelerated MVAC.  

If you have accelerated MVAC you have methotrexate, vinblastine, doxorubicin and cisplatin on the same day.  You then have them again 2 weeks later.

After chemotherapy you may also have a drug called GCSF Open a glossary item. 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 (standard MVAC) you have each cycle in the following way:

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.

What are the side effects of MVAC?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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 advice line 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:

Allergic reaction

Some people can have an allergic reaction while having this treatment. You might have some medication before to prevent this from happening. Let your nurse or doctor know straight away if any of the following happen:

a skin rash


swelling of the lips, face or throat

shortness of breath

Your nurse will keep a close eye on you and act straight away if this happens.

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 thinning

Your hair may thin but you’re unlikely to lose all your hair. This usually starts after your first or second cycle of treatment. It is almost always temporary and your hair will grow back when you finish your treatment.

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.

This can cause not being able to pass urine, passing urine frequently, pain when passing urine. It can also cause your kidneys not work very well or stop working.

Contact your doctor or the advice line if you have problems with passing urine.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat 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 and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.


Contact your advice line if you have diarrhoea. For example, 2 or more extra loose bowel movements than usual each day. If you have a stoma, you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.


Constipation Open a glossary item is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can prescribe a laxative.

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.

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.


Contact your doctor or pharmacist if you have indigestion. They can prescribe something for it.

Weight loss

You might lose weight while having this treatment. Let your doctor or nurse know and they can recommend ways of maintaining your weight. Or they can refer you to a dietitian.


Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Numbness and tingling in hands and feet

Numbness or tingling in your hands or feet is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.

Skin blisters

Your skin might blister. Tell your doctor or contact the advice line.

Pain or discomfort

You might have pain or discomfort in the muscles, jaw, bones or where your cancer is. Tell your doctor if you do.

High levels of uric acid in the blood

High levels of uric acid in your blood can lead to a build up of crystals in body tissues and cause inflamed joints. You have regular blood tests to check your levels. Drinking plenty of fluid helps to flush out the excess uric acid. You might also have medicines to control uric acid levels.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Lung changes

You might have changes to how well your lungs work. This can cause shortness of breath, coughing, wheezing and chest pain. You might also have a temperature. Tell your doctor or contact the advice line if you have any of these.

Low sodium levels in your blood

You might have a low level of a mineral called sodium in your blood. Depending on how low the level is it can cause you to feel tired and lacking in energy, lose your appetite, have a headache or feeling sick or being sick.

Your doctor checks the levels regularly when you have a blood test.  

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you some medicine.

Changes to hearing

You may get ringing in your ears (tinnitus). This normally gets better on its own. You may have some hearing loss, especially with high pitched sounds. 

Tell your doctor or nurse if you notice any changes.

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

  • skin changes such as a rash, darkening of the skin or itchy skin
  • inflammation of the bladder causing blood in the urine
  • changes to how your heart works such as changes to the beat and rhythm or on rare occasions heart attack
  • blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • dizziness
  • feeling unusually sleepy during the day (drowsiness)
  • red and sore where you have had radiotherapy
  • skin becoming sensitive to sunlight and bright light
  • nail changes
  • seizures (fits)
  • muscle weakness
  • difficulty walking and feeling unsteady
  • depression

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:

  • sore eyes and changes to eyesight such as blurred vision
  • changes to the brain causing temporary changes to attention and concentration, difficulty thinking and remembering
  • diabetes
  • weakness in one side of the body or not able to move one side
  • feels like everything is spinning around you (vertigo)
  • inflammation of the blood vessels
  • blood in diarrhoea and vomit
  • inflammation of the pancreas
  • ongoing liver problems such as cirrhosis, fibrosis and fatty liver
  • changes to skin colour and skin rash some which can be severe
  • wounds not healing
  • stiff joints
  • weak bones (osteoporosis)
  • inflammation of the vagina and ulcers
  • an increased level of magnesium in the blood
  • thickening and hardening of the veins
  • bleeding from the gut
  • ulcers in the large bowel (colon) and death of tissue in the colon
  • inflammation of the food pipe (oesophagus)
  • not enough water in the body (dehydration)
  • high or low levels of minerals in the blood that can cause muscle cramps
  • an increased risk of developing cancer of the lymph nodes (lymphoma)

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • hot flushes
  • difficulty digesting food or getting nutrients from food (malabsorption)
  • severe swelling of the large bowel (colon)
  • jaw pain and damage to the jawbone
  • recurrence of hepatitis B
  • worsening of hepatitis C
  • high blood pressure that can cause headaches, nose bleeds, blurred or double vision or shortness of breath
  • redness, swelling or leaking at your drip site
  • red, watery eyes (conjunctivitis)
  • an increased risk of developing a cancer of the blood called leukaemia

Coping with side effects

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

What else do I need to know?

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.


Methotrexate contains small amounts of alcohol. This is not harmful to most people but may be if you have alcohol problems.

Loss of fertility

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment. 

Contraception and pregnancy

This treatment might harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for a few months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.


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

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.


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 one of the shingles vaccines called Zostavax.

You can have:

  • other vaccines, but they might not give you as much protection as usual
  • the flu vaccine (as an injection)
  • the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system Open a glossary item recovers from treatment.

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. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. 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 and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

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

  • Electronic Medicines Compendium 
    Accessed September 2021

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Consent forms for SACT (Systemic Anti-Cancer Therapy)​
    Cancer Research UK, Accessed September 2018

  • Contemporary best practice in the use of neoadjuvant chemotherapy in muscle-invasive bladder cancer

    Gautier M and others

    Therapeutic advances in urology eCollection Jan-Dec 2019

  • Efficacy and Safety of Chemotherapy Regimens in Advanced or Metastatic Bladder and Urothelial Carcinomas: An Updated Network Meta-Analysis

    Hong-Chen Que and others

    Frontiers in Pharmacology 15 January 2020

  • Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (ddMVAC) with Gemcitabine and Cisplatin (GC) as Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Systematic Review and Meta-Analysis

    Doo Yong Chung and others

    Cancers 2021 June Vol 13 issue 11

  • NICE Guidelines 

    Accessed August 2021

Last reviewed: 
23 May 2022
Next review due: 
23 May 2025

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