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
. 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
. 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:
- You have methotrexate as an injection into your bloodstream.
- 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.
- You have no treatment
- You have methotrexate as an injection into your bloodstream.
- You have vinblastine as a drip into your bloodstream.
- You have no treatment.
- You have methotrexate as an injection into your bloodstream.
- You have vinblastine as a drip into your bloodstream.
- You have no treatment
Then you start a new cycle of treatment.
Tests
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?
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.
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.
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
itching
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.
Breathlessness
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. Avoiding fatty or fried foods, try 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 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 the mouth moist. Tell your doctor or nurse if you have ulcers.Diarrhoea
Contact your advice line if you have
diarrhoea
, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
Constipation
Constipation
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 doctor, nurse or pharmacist if you are constipated for more than 3 days. 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.Indigestion
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.
Headache
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.
Alcohol
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 falls 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 falls pregnant while having treatment.
Breastfeeding
Don’t breastfeed during this treatment. This is 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. For example, if you need treatment for anything else, including teeth problems.
Immunisations
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
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.
