Cisplatin, methotrexate , doxorubicin (Adriamycin) and vinblastine are active single chemotherapy agents and have been combined into a number of programs. Popular regimens include:
• Methotrexate + vinblastine + Adriamycin + cisplatin (M-VAC). Studies have proven that M-VAC is better
than both CISCA 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
in 10 to 15 percent.
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 Adriamycin toxicity. CMV can be given to those who cannot take
Adriamycin. Even when kidney and heart function are normal, full doses of Adriamycin 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
