Cisplatin, methotrexate , doxorubicin and vinblastine are active single chemotherapy agents and have been combined into a number of programs. Popular regimens include:
• Methotrexate + vinblastine + doxorubicin + cisplatin (M-VAC). Studies have proven that M-VAC is better
than both CISCA (see below) and cisplatin alone and is the treatment of choice. Thirty-five to 70 percent of
patients will respond, with 15 to 35 percent having a complete tumor regression that sometimes lasts more than
five years.
The use of M-VAC is limited, however, by the need to maintain good kidney function (cisplatin and
methotrexate are both excreted by the kidney) and the requirement that the patients cannot have significant
cardiac abnormalities because of doxorubicin toxicity. CMV can be given to those who cannot take doxorubicin.
Even when kidney and heart function are normal, full doses of doxorubicin or M-VAC can result in major
complications in almost a quarter of cases.
• Investigational studies suggest that toxicity can be decreased and even higher M-VAC doses can be given when
combined with granulocyte macrophage-colony stimulating factor (GM-CSF) or granulocyte colony stimulating
