MVAC is a chemotherapy treatment used to treat bladder cancer.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
The drugs used in MVAC
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MVAC comes from the name and initials of the drugs used:
You usually have MVAC in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse gives you anti-sickness drugs as tablets or as an injection into a vein. They give you the drugs and chemotherapy through one of the following:
a short thin tube (cannula) the nurse puts into a vein in your arm or hand.
a fine tube that goes under the skin of your chest and into a vein close by (central line).
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you:
methotrexate as a slow injection into your cannula or line - you will usually have fluids through a drip at the same time
vinblastine as a drip (infusion) into your cannula or line over 5–10 minutes
doxorubicin (a red liquid) as a slow injection into your cannula or line
cisplatin as a drip over 1 -8 hours.
Your nurse will run the drip through a pump, which gives you the treatment over a set time. You will have fluids through a drip before and after the cisplatin.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Rarely, cisplatin can cause an allergic reaction while being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having treatment it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Your course of MVAC
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. A cycle of MVAC is either given over two weeks (14 days) or four weeks (28 days). When MVAC is given over two weeks it is called Accelerated MVAC.
On a two weekly cycle
On day one you usually have methotrexate, vinblastine, doxorubicin and cisplatin. After this you have no more chemotherapy for 13 days. This completes a cycle of your treatment.
On a four weekly cycle
You may have all the drugs given on day one or over two days. You then have methotrexate and vinblastine again on days 15 and 22. After this you have no more chemotherapy for 6 days. This completes a cycle of your treatment.
You will have three to six cycles of MVAC in total. Your nurse or doctor will discuss your treatment plan with you.
Before you go home the nurse or pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as they have explained to you.
You might also be given tablets called folinic acid (Leucovorin) to start 24 hours after the methotrexate. This is to reduce side effects. It's very important to take the tablets on time and to take them all exactly as explained to you.
Possible side effects of MVAC
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We explain the most common side effects of MVAC here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low it’s called neutropenia. Your nurse may give you injections of a drug called GCSF under the skin. It encourages the bone marrow (where blood cells are made) to make more white blood cells.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell , even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and return to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
MVAC can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red cells (blood transfusion).
This may happen in the first few days of treatment. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Your urine may be a pink-red colour for up to 48 hours after you’ve had your treatment. This is due to the colour of doxorubicin.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
The treatment may make you constipated and cause tummy pain. Drinking at least two litres of fluids (three and a half pints) every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take some regular gentle exercise.
You may get pain or discomfort in your tummy (abdomen), feel bloated or have indigestion or wind. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve or gets worse.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Methotrexate can cause a rash, which may be itchy. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin or vinblastine on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this.
Changes in the way the kidneys work
Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing.
Changes in the way the liver works
Cisplatin may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Vinblastine may cause pain in your jaw. Tell your nurse or doctor if you notice this.
Changes in hearing
Cisplatin can affect your hearing. You may have a hearing test before you start treatment. You may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
Your eyes may become watery and feel sore and may become more sensitive to light. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops. MVAC may also cause blurry vision or eye pain. Always tell your doctor or nurse if you have eye problems or notice any change in your vision.
Less common side effects of MVAC
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Changes in the way the heart works
Rarely MVAC can affect the way the heart works but this is usually temporary. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you notice changes to your heartbeat, have pain or tightness in your chest, or feel breathless at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions but it’s important to get them checked by a doctor.
Effects on the lungs
This treatment can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Effects on the nervous system
MVAC can affect the nervous system. You may feel confused, dizzy or unsteady. Tell your doctor or nurse straight away if you notice any of these symptoms. They may make some changes to your treatment if they become a problem for you. It’s important not to drive or operate machinery if you notice these effects. Rarely, this treatment can cause seizures (fits).
Other information about MVAC
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Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your doctor will advise you not to drink alcohol while you're having methotrexate as they can interact with each other.
MVAC may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed July 2013)
Perry MC. The Chemotherapy Source Book. 5th edition. 2012 Lippincott Williams and Wilkins.
With thanks to Netty Cracknell (Wood), Lead Pharmacist Electronic Prescribing, who reviewed this edition.
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