Feasibility and safety of accelerated MVAC (aMVAC) in geriatric patients with muscle-invasive bladder cancer.

Dose-dense MVAC (ddMVAC) is a standard regimen for muscle-invasive bladder cancer (MIBC), but tolerability concerns often limit its use in geriatric patients. Accelerated MVAC (aMVAC), delivered as a single-day regimen, may reduce hospital visits and resource use. This study assessed the feasibility and safety of aMVAC in geriatric patients with MIBC in a real-world, resource-constrained setting. We included patients aged 60 years or older with histologically confirmed MIBC (stages II-IV). Eligible patients received three or four cycles of single-day aMVAC (methotrexate 30 mg/m², vinblastine 3 mg/m², doxorubicin 30 mg/m², cisplatin 70 mg/m²) every 14 days, with growth factor support. Feasibility was defined as completing 3 or 4 cycles within the protocol-defined duration. Toxicities were graded per CTCAE v5.0. Among 33 geriatric patients, 30 (90.9%) completed ≥ 3 cycles, and 28 (84.8%) completed four cycles within the planned timeframe. Dose reductions for grade 3 or higher toxicities were required in 10 (30.3%) patients, and treatment discontinuation occurred in 3 (9%). Grade 3 hematologic events occurred in 12% and non-hematologic events in 33.3%; the most common were anemia, mucositis, and fatigue. No grade 4 toxicities, febrile neutropenia, or treatment-related deaths were observed. Pathological complete response (pCR; ypT0N0) was achieved in 8 (36.4%) patients, and 12 (54.5%) patients had pathologic down-staging compared with their clinical stage. aMVAC is a feasible regimen for geriatric patients with MIBC, achieving high treatment completion rates and acceptable toxicity. The simplified one-day protocol reduces hospital stay and logistical burden while maintaining therapeutic intensity. aMVAC represents a practical and feasible alternative in real-world, resource-limited settings.Clinical Trial RegistrationThe trial was registered under clinical trial registry of India : CTRI/2021/10/037450.