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This information is about a chemotherapy treatment for bladder cancer called MVAC. It describes the drugs used, how they are given, and some of their possible side effects. If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
MVAC is named after the initials of the chemotherapy drugs used, which are:
MVAC treatment may involve an overnight stay in hospital as well as attending as a day patient. You will need to have a blood test before you start treatment – either on the same day, or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
Each treatment of MVAC is called a cycle. A cycle of treatment usually takes 28 days but you will only be given treatment on a few days out of each 28 day cycle. Usually you are given between four and six cycles of treatment. The treatment is given as a drip (infusion) through a fine tube (cannula) inserted into the vein, or through a central line which is placed under the skin into a vein near the collarbone, or into a PICC line which is inserted into a vein in the crook of the arm.
On treatment days you will be given anti-sickness medicines before chemotherapy. Before you are given cisplatin you will also be given plenty of fluid through a drip to keep your kidneys working normally. This may mean you will need to stay in hospital overnight.
MVAC chemotherapy can be given in different ways. Your doctor or nurse can tell you how MVAC is given in your hospital. You may hear the word regimen (eg the MVAC regimen) used when talking about your chemotherapy. This means the whole plan, or schedule, of the particular chemotherapy treatment that you are having. The exact schedule may vary between hospitals.
Usually, on the first two days of treatment (day 1 and day 2) you will be given each of the four chemotherapy drugs; methotrexate, vinblastine, doxorubicin and cisplatin. You will also be given intravenous fluids (drips) for several hours. You may be given folinic acid tablets to take after your methotrexate to help prevent side effects associated with the methotrexate.
After you have been given the drugs you can usually go home.
On days 15 and 22 you are likely to come back as a day patient to have further methotrexate and vinblastine chemotherapy. You will then have a rest period with no chemotherapy for a week.
This completes what is called a cycle of your treatment. Each cycle lasts four weeks.
Usually 4–6 cycles of MVAC are given over a period of 4–6 months. This makes up a course of treatment.
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone who is having MVAC chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare, and therefore unlikely to affect you. If you notice any effects that you think may be due to the chemotherapy or any other medicines, but which are not listed here, please let your nurse or doctor know.
Tiredness You may feel very tired during chemotherapy. It can take several months to recover your energy levels fully after treatment is over. You may also feel tired if the number of red blood cells in your blood is reduced (anaemia). This may also make you feel breathless. Your doctor may arrange for you to have a blood transfusion.
Lowered resistance to infection The number of white blood cells made in the bone marrow can be affected by treatment, making you more prone to infection. You should contact your doctor straight away if you think you have an infection. Your white blood cells will usually have recovered before your next cycle of chemotherapy is due.
Bruising or bleeding The number of blood clotting cells (platelets) in your blood may be reduced. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Hair loss This usually starts 3–4 weeks after the first treatment with MVAC. You will usually lose all your hair. Your eyelashes, eyebrows and other body hair may also fall out. Hair loss is temporary and your hair will start to grow again once the treatment has finished.
Watery eyes Your eyes may become watery and more sensitive to sunlight. Less commonly treatment can cause eye pain or blurred vision. If you notice any changes let your doctor know. They may prescribe eye drops to help.
Skin changes During the treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes.
Sore mouth and taste changes Your mouth may become sore 2–3 days after treatment. This usually gets better before the next treatment is due. Tell your doctor or nurse if you are affected. You may be given mouthwashes and medicine to prevent or clear infection in the mouth. Any taste changes usually return to normal after treatment finishes.
Feeling sick (nausea) or being sick (vomiting) Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If your sickness isn't controlled, or if it continues, tell your doctor. They may be able to give you another type of anti-sickness drug that will help. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Changes in hearing You may have ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Again, this effect usually decreases when the treatment ends, although in a small number of cases it may be permanent. Tell your doctor if you notice any loss of hearing or tinnitus.
Your kidneys may be affected Usually this does not cause any symptoms and any effect is mild, but your kidneys will be checked by a blood test before each treatment.
Discoloured urine Your urine may become a pink-red colour following doxorubicin treatment. This colour change is harmless and may last for up to a day after treatment.
Numbness or tingling in hands or feet This is due to the effect of cisplatin or vinblastine on nerves and is known as peripheral neuropathy. You may notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. The side effect usually disappears slowly a few months after the treatment ends.
Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by taking this treatment. It is important to discuss your fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while having MVAC chemotherapy, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor.
If you feel unwell or notice any changes that are not listed here, it is important to let your doctor know and ask for advice.
This section is based upon our MVAC chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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