MVAC

MVAC is the name of a chemotherapy combination that includes: 

• M - methotrexate (pronounced meth-oh-treks-ayt)

• V - vinblastine (vin-blas-teen)

• A - doxorubicin (doks-oh-roo-bi-sin) - also called Adriamycin

• C - cisplatin (sis-pla-tin)

It is a treatment for bladder cancer.

A small number of people may have it as a treatment for upper urinary tract urothelial cancer that has spread (advanced upper urinary tract urothelial cancer). 

How does MVAC work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have MVAC?

You have MVAC into your bloodstream (intravenously). 

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.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

How often do you have MVAC?

You usually have these drugs as cycles of treatment . Each cycle takes either 14 days (2 weeks) or 28 days (4 weeks). When you have MVAC over 2 weeks it is called accelerated MVAC. If you have MVAC over 4 weeks it is called standard MVAC.

Usually, you have between 3 to 6 cycles of standard or accelerated MVAC. 

Accelerated MVAC

You can have accelerated MVAC in slightly different ways. This is one way of having it:

Then you start a new cycle of treatment. 

You will have a drug called folinic acid 24 hours after having methotrexate. It protects you against the side effects of methotrexate. You usually have it every 6 hours until your blood levels of methotrexate drop to a safe level. If your methotrexate levels are very high, you might have it every 3 hours.

After chemotherapy you may also have a drug called a Granulocyte colony stimulating factor (G-CSF). You have it as injections under the skin. G-CSF encourages the bone marrow to make more white blood cells . This lowers your chance of getting an infection.

Standard MVAC

You have each cycle of standard MVAC in the following way:

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.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

You have heart tests such as an ECHO (echocardiogram), ECG (electrocardiogram) or both before treatment. You may continue to have heart tests during and after treatment with doxorubicin.

You also normally have hearing tests before and during your treatment. Sometimes your doctors might ask you to have other tests. They will tell you what these are for and how to prepare for them.
 

What are the side effects of MVAC?

Side effects 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. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

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:

Increased 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, cough, headaches, feeling cold and shivery, pain or a burning feeling when weeing, or generally feeling 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. 

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).

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills.

Allergic reactions can sometimes be life threatening. Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

Changes to the levels of minerals in your blood

You may have changes in the levels of minerals in your blood. It’s common to have low levels of sodium. And high levels of uric acid, which can cause gout. Rarely, you might have low levels of magnesium in your blood.

You'll have regular blood tests during treatment to check these levels.

A sore mouth

It’s common to get a sore mouth and mouth ulcers. This can make it painful to swallow drinks or food. Tell your healthcare team if you have these symptoms. They may give you painkillers to help reduce the soreness. Take them half an hour before meals to make eating easier. You have mouthwashes to keep your mouth healthy.

Inflammation and ulcers

Areas of the body can be affected by inflammation and ulcers. This includes the vagina  and food pipe (oesophagus), but this is less common.

Rarely you might have ulcers in the large bowel (colon). Or inflammation of the small bowel which can cause bloody loose poo. You can also get bleeding from the stomach. You might have dark, smelly poo or blood in your sick.

Contact your helpline immediately if you notice any of these symptoms.

Tummy (abdominal) pain

You might get pain in your abdomen. Less often you might get a burning feeling in your abdomen. Contact your advice line if you have either of these. Depending on what is causing the pain, they might give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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.

Diarrhoea 

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Kidney damage

Your kidneys may stop working properly. Symptoms include not passing enough pee, feeling breathless, tired and weak. You may also feel confused, sick, and have swelling of your legs, ankles and feet.

You have regular blood tests to check for this. But call your advice line if you have any of these symptoms.

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.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Swelling of the veins and blood clots

You might get swelling of the veins. This can be caused by a blood clot .

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include pain, redness and swelling around where the clot is, the area feeling warm to touch, breathlessness, coughing up blood, pain in your chest or upper back.

Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot. You should dial 999 if you have chest pain.

Rarely you might get thickening and hardening of the veins.

Skin and nail problems

This treatment can cause changes to your skin and nails.

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.  

Your skin might also be more sensitive to sunlight causing a reaction. It’s important to protect your skin by keeping in the shade, covering up your skin and wearing sunscreen.

You may also get a rash or your skin may redden. Your nails may come away at the nail bed. Less often your skin may be itchy or you may have areas of your skin or nails that appear darker than usual. You might have skin changes in an area where you have had radiotherapy.

Rarely you may get a severe skin reaction called Stevens Johnson syndrome. This can start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish, and your eyes may be more sensitive to light. This is serious and could be life threatening.

Let your healthcare team know straight away of any skin changes that develop. They can find out the cause. They might be able to prescribe medicine to help or give advice on what creams to use to look after your skin.

Lack of energy and strength

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Heart problems

You may get heart problems such as a change in your heart rhythm, or your heart muscle might not work as well as it did. You may not get any symptoms with these. If you do, symptoms can include feeling your heart is beating very fast or slow, dizziness and shortness of breath.

Rarely, this treatment can cause a heart attack.

Your doctor will check you for heart problems but tell them straight away if you have any of these symptoms.

Mild 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.

Rarely this treatment can cause scarring (cirrhosis), fattening or liver failure. You have regular blood tests to check on how well your liver is working.

Some liver changes and problems can cause yellowing of the skin and whites of the eyes. This is called jaundice. Let your doctor or nurse know straight away if you have this.

Changes to hearing

You might have some hearing loss, especially with high pitched sounds. You might also have some ringing in your ears (tinnitus). 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:

• sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, a very high or very low temperature, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
• headaches
• dizziness
• feeling off balance and like you or the room is spinning around you (vertigo)
• feeling drowsy
• changes to your lung tissue causing difficulty breathing, a dry cough and fatigue. Rarely there might be pain and thickening of the layer of tissue that covers the lung
• eye problems such as infection (conjunctivitis), blurred vision, temporary loss of vision, or your eyes might be sensitive to light
• pain or blood when you have a wee. - this is caused by inflammation of the bladder. Tell your doctor know if you get these symptoms
• unexpected bleeding, such as blood in your poo, vaginal bleeding, or coughing up blood. Or if you have any other unusual bleeding. Contact your healthcare team straight away

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• inflammation of the pancreas causing symptoms such as tummy pain, feeling or being sick, loose watery poo and a high temperature
• wounds that are slow to heal
• seizures (fits), weakness or inability to move on one side, confusion, problems with movement, feeling sluggish or fatigued, problems with thinking
• a second cancer such as acute leukaemia or lymphoma
• loss of body fluid (dehydration)
• high blood sugar levels (diabetes) - symptoms can include headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels
• feeling very low (depression)
• muscle or joint pain
• weakening of the bones (osteoporosis)
• painful swollen breasts
• taste changes - this can include a metallic taste in your mouth

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:

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

If you have other side effects that aren’t listed on this page, you can look at the individual drug pages:

• methotrexate
• vinblastine
• doxorubicin
• cisplatin
   

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 medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment.

Women should not become pregnant for at least 7 months after the end of treatment. Men should not get someone pregnant for at least 4 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

Don’t breastfeed during this treatment and for at least 4 weeks after. This is because the drugs may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

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, and yellow fever.

You can usually 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 a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug 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.