This information is about a chemotherapy treatment for bladder cancer called MVAC.
You'll see your hospital doctor regularly while you have this treatment so they can monitor the effects of the chemotherapy.
The drugs that are used
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MVAC is named after the initials of the chemotherapy drugs used, which are:
How treatment is given
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MVAC treatment may involve an overnight stay in hospital as well as attending as a day patient. Before the treatment starts you'll need to have a blood test on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. You'll also have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours, or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. This may take a couple of hours.
The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a fine, plastic tube that is inserted under the skin and into a vein near their collarbone (central line), or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
Once your chemotherapy is ready you'll be given anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula or line, which is connected to a drip. Some anti-sickness medicines may also be given as tablets.
The chemotherapy drugs are then given separately:
Methotrexate (a yellow fluid) is given as an injection into your cannula or line.
Vinblastine (a colourless fluid) is given as a short drip (infusion).
Doxorubicin (a red fluid) is given as an injection into the cannula or line.
Cisplatin (a colourless fluid) is given as an infusion.
Before you're given cisplatin you'll be given plenty of fluid through an infusion to keep your kidneys working normally. This may mean you'll need to stay in hospital overnight.
Once the treatment is finished you can go home. Your cannula will be removed before you go. If you have a central or PICC line it will usually stay in place ready for the next cycle of your chemotherapy. You'll be shown how to look after the line.
You'll be given a supply of anti-sickness drugs to take home with you. It's important to take these as directed, even if you aren't feeling sick, as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
How often treatment is given
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You may hear your doctor use the word 'regimen' (eg the MVAC regimen) when talking about your chemotherapy. This refers to the whole plan or schedule of the particular chemotherapy treatment that you're having.
MVAC chemotherapy can be given in different ways and the schedule may vary between hospitals. The following is one description of giving MVAC. Your doctor or nurse will explain how you'll have the treatment.
Usually, on the first two days of treatment (day 1 and day 2) you'll be given each of the four chemotherapy drugs (methotrexate, vinblastine, doxorubicin and cisplatin) as described above. You'll also be given intravenous fluids (drips) for several hours. You may be given folinic acid tablets to take after your methotrexate to help prevent some of the side effects that it can cause.
After you have been given the drugs you can usually go home.
On days 15 and 22, you're likely to come back as a day patient for further methotrexate and vinblastine chemotherapy. You'll then have a rest period with no chemotherapy for a week.
This completes what is called a cycle of your treatment. Each cycle lasts 28 days (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 here won't affect everyone who has MVAC chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
MVAC can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you'll be more prone to infections. A low white cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
MVAC can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
MVAC can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Hair loss usually starts 3-4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and hair in other areas of the body. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss. You can also watch our video of Bengu telling her story of coping with hair loss.
Your eyes may become watery and more sensitive to sunlight. Less commonly, treatment can cause eye pain or blurred vision. Let your doctor know so they can prescribe soothing eye drops if necessary.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our slideshow on mouth care during chemotherapy helpful.
Your kidneys may be affected
This doesn't usually cause any symptoms and the effect is generally mild. Your kidneys will be checked by a blood test before each treatment.
Your urine may become a pink-red colour. This may last up to 48 hours after you’ve had your treatment. It is normal and is due to the colour of the doxorubicin.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Less common side effects
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During treatment with MVAC and for several months afterwards, you'll be more sensitive to the sun, and your skin may burn more easily than normal. You can still go out in the sun but should wear a suncream with a high sun protection factor (SPF), and cover up with clothing and a hat. You might find our page on taking care in the sun useful.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally, your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Numbness or tingling in hands or feet
This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may also 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. It is important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
MVAC can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Treatment with MVAC may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Fever and chills
These may occur from the time that your treatment is given, but they don’t usually last long. Your doctor may prescribe medicines to reduce these effects.
Changes in the way your heart works
This is very rare with standard doses of doxorubicin but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and sometimes before each treatment.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You'll be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Leakage into the tissue around the vein (extravasation)
If this happens when doxorubicin or vincristine are being given, the tissue in that area can become damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central line or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you're at home, ring the clinic or ward and ask to speak to the doctor or nurse.
You may have a sudden feeling of warmth and some reddening in your face. This can happen for a short period of time while the drug is being given.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and 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’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Some painkillers, such as ibuprofen, can make the side effects of methotrexate worse. Before taking any painkillers, check with your chemotherapy nurse, pharmacist or doctor.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss your fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having MVAC chemotherapy, as it may harm the developing baby. It's important to use effective contraception while taking these drugs and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our MVAC chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott, Williams and Wilkins.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).