Disease relapse after neoadjuvant cisplatin, methotrexate and vinblastine (CMV) chemotherapy plus radical cystectomy in locally advanced bladder cancer

From 1986 until today 32 patients with metastatic bladder cancer were treated by Cisplatin, Methotrexate and Vinblastine (CMV) chemotherapy. We divided these patients into three groups: 13 patients with disease relapse after neoadjuvant CMV chemotherapy and radical cystectomy (group A); 11 pts with disease relapse after radical cystectomy alone (group B) and 8 pts. with metastatic bladder cancer as first clinical observation and not surgically pretreated (group C). We performed a total of 88 cycles, in accordance with Harker's schedule, because 8 pts. stopped chemotherapy for heavy toxicity(2 deaths). Median survival was 9.8 months in group A, 16.9 months in group B and 6.3 months in group C. In our opinion, the efficacy of chemotherapy is greater in patients who have never undergone this treatment before than in those where a neoadjuvant therapy has been performed. Probably it depends upon the heavy cumulative toxicity and selection of chemoresistant cellular clones.