Supplementary Material for: Tolerability and Efficacy of Neoadjuvant Chemotherapy with a Tri-Weekly Interval Methotrexate, Doxorubicin, Vinblastine, and Cisplatin Regimen for Patients with Locally Advanced Bladder Cancer

<b><i>Objective:</i></b> Compared with standard treatment, a modified tri-weekly MVAC (methotrexate, doxorubicin, vinblastine, and cisplatin) treatment regimen with a high cisplatin dose intensity shows good efficacy and lower toxicity. Thus, we retrospectively investigated the tolerability and efficacy of a modified tri-weekly MVAC neoadjuvant regimen. <b><i>Methods:</i></b> We analyzed 25 patients with locally advanced bladder cancer medicated by a modified tri-weekly MVAC neoadjuvant regimen that omits treatment on days 15 and 22. The efficacy and tolerability were assessed retrospectively. <b><i>Results:</i></b> The numbers of patients in clinical stages 2, 3, and 4 were 13 (52.0%), 1 (4.0%), and 11 (44.0%), respectively. Surgery could be performed on all patients. Five patients (20.0%) had no cancer remaining in their surgical specimens. Remaining non-muscle-invasive cancer without metastasis was observed in 7 patients (28.0%), and the total downstaging rate was 44.0%. The 5-year overall and relapse-free survival rates were 79.0 and 75.0%, respectively. The overall relative dose intensity was 0.90. Serious hematologic toxicities rated grade 3 or greater were leukopenia in 6 patients (24.0%) and anemia in 1 patient (4.0%). <b><i>Conclusions:</i></b> Sufficient efficacy and tolerability of a modified tri-weekly MVAC neoadjuvant regimen were suggested. Thus, tri-weekly modified MVAC may be an option for neoadjuvant chemotherapy of advanced bladder cancer.

**研究目的：** 相较于标准治疗方案，提升顺铂剂量强度的改良型每三周一次MVAC（甲氨蝶呤、多柔比星、长春碱和顺铂）化疗方案展现出更优异的疗效与更低的毒性。为此，本研究回顾性探讨了该改良型每三周一次MVAC新辅助化疗方案的耐受性与疗效。
**方法：** 本研究回顾性分析了25例局部晚期膀胱癌患者，所有患者均接受了省略第15天与第22天给药的改良型每三周一次MVAC新辅助化疗方案，本研究对该方案的疗效与耐受性进行了回顾性评估。
**结果：** 临床分期为2期、3期、4期的患者分别为13例（52.0%）、1例（4.0%）与11例（44.0%）。所有患者均顺利完成手术。其中5例患者（20.0%）的手术标本中未检出残留癌组织；7例患者（28.0%）检出残留非肌层浸润性癌且无远处转移；整体降期率为44.0%。患者的5年总生存率与无复发生存率分别为79.0%与75.0%。整体相对剂量强度为0.90。≥3级的严重血液学毒性包括6例（24.0%）白细胞减少与1例（4.0%）贫血。
**结论：** 本研究提示改良型每三周一次MVAC新辅助化疗方案具备充足的疗效与良好的耐受性。因此，该每三周一次的改良MVAC方案可作为晚期膀胱癌新辅助化疗的可选方案之一。