methotrexate + vinblastine + doxorubicin + cisplatin + G-CSF

This regimen is a combination chemotherapy protocol consisting of four cytotoxic agents—methotrexate, vinblastine, doxorubicin, and cisplatin—administered together with granulocyte colony-stimulating factor (G-CSF) as supportive care. It is most commonly referred to as "MVAC plus G-CSF," "high-dose MVAC" (HD-MVAC), or "dose-dense MVAC" (ddMVAC). The primary indication for this regimen is the treatment of advanced or metastatic urothelial carcinoma (including transitional cell carcinoma of the bladder and upper urinary tract)[1][2][5]. - **Methotrexate** is an antimetabolite that inhibits dihydrofolate reductase, blocking DNA synthesis. - **Vinblastine** disrupts microtubule formation by binding tubulin, inhibiting mitosis. - **Doxorubicin** intercalates into DNA and inhibits topoisomerase II, causing DNA strand breaks; it also generates free radicals. - **Cisplatin** forms DNA crosslinks leading to apoptosis in rapidly dividing cells. G-CSF is included to reduce the risk of neutropenia by stimulating bone marrow production of neutrophils[7][10]. This allows for higher dose intensity or shorter intervals between cycles compared to classic MVAC regimens without G-CSF[1][5]. The addition of G-CSF has been shown to reduce severe myelosuppression and improve treatment tolerability while maintaining or improving efficacy in terms of response rates and survival outcomes[1][5].

Other names

MVAC plus G-CSFHD-MVACddMVAC