{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T20:28:16Z","timestamp":1787257696616,"version":"build-2736575974"},"reference-count":16,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Muscle-invasive bladder carcinoma (MIBC) poses major treatment challenges in low- and middle-income countries because of logistical and socioeconomic barriers limiting neoadjuvant chemotherapy (NAC) delivery. While dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) improves pathologic response and survival over gemcitabine-cisplatin, its multiday schedule reduces practicality. Accelerated MVAC (AMVAC), a single-day outpatient regimen, may offer a feasible alternative. This study evaluated the feasibility and safety of AMVAC in Indian patients with MIBC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We conducted a single-arm feasibility study at the All India Institute of Medical Sciences, Rishikesh, India, between December 2021 and November 2024. Adults with stage II-III MIBC and cisplatin eligibility received 3-4 cycles of single-day AMVAC with pegfilgrastim support before radical cystectomy. Feasibility was defined as completion of \u22653 or 4 cycles within protocol-specified timeframes. Toxicities were graded using CTCAE v5.0, and outcomes were analyzed descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Sixty patients were enrolled (mean age 55.2 \u00b1 11.2 years; 90% male); 55 received neoadjuvant, and five adjuvant therapy. The mean number of chemotherapy cycles delivered was 3.87 \u00b1 0.85. Feasibility outcomes were favorable, with 91.6% completing three and 76.6% completing four cycles within protocol timelines. Dose reductions for grade \u22653 toxicities were required in 13 patients (21.7%), whereas four patients discontinued treatment because of reduced creatinine clearance. Grade 3 adverse events occurred in 38.3%, most commonly anemia (16.7%), fatigue, and mucositis (13.3% each). Among neoadjuvant recipients undergoing cystectomy (n = 40), pathologic complete response (PCR) was achieved in 32.5% and pathologic downstaging was achieved in 55%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Single-day AMVAC is a feasible and tolerable NAC regimen in a resource-constrained setting, with encouraging PCR and manageable toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-26-00219","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T19:59:07Z","timestamp":1787255947000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Accelerated Methotrexate, Vinblastine, Doxorubicin, and Cisplatin for Muscle-Invasive Bladder Cancer: Real-World Feasibility and Safety in a Resource-Constrained Setting"],"prefix":"10.1200","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6378-7694","authenticated-orcid":true,"given":"Deepak","family":"Sundriyal","sequence":"first","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6245-9739","authenticated-orcid":true,"given":"Sai","family":"Prasath","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0796-4502","authenticated-orcid":true,"given":"Harsha S.","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9380-5144","authenticated-orcid":true,"given":"Anusha Mruthyunjaya","family":"Swamy","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7821-2058","authenticated-orcid":true,"given":"Karthik","family":"Jayalingappa","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7764-0044","authenticated-orcid":true,"given":"Mayank","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2899-4385","authenticated-orcid":true,"given":"Mahesh","family":"Koulagi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2970-5368","authenticated-orcid":true,"given":"Deepa","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3893-2781","authenticated-orcid":true,"given":"Sweety","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1090-4671","authenticated-orcid":true,"given":"Parmod","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3423-496X","authenticated-orcid":true,"given":"Ujjawal","family":"Shriwastav","sequence":"additional","affiliation":[{"name":"Department of Medicine, Chitwan Medical College, Bharatpur, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7100-8999","authenticated-orcid":true,"given":"Amit","family":"Sehrawat","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_6_2_2","unstructured":"Predictions of the future cancer incidence and mortality burden worldwide up until 2050. https:\/\/gco.iarc.fr\/tomorrow\/en"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.27805"},{"key":"e_1_3_6_4_2","unstructured":"National Comprehensive Cancer Network (NCCN): NCCN clinical practice guidelines in oncology: Bladder cancer 2026. Version 1.2026 https:\/\/www.nccn.org"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12672-025-02796-6"},{"key":"e_1_3_6_6_2","first-page":"e85071","article-title":"A comparative study of Gemcitabine-Cisplatin vs. dose-dense MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) as neoadjuvant chemotherapy for muscle-invasive bladder cancer: A single-institution experience","volume":"17","author":"Goel V","year":"2025","unstructured":"Goel V, Jain A, Basu DA, et al: A comparative study of Gemcitabine-Cisplatin vs. dose-dense MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) as neoadjuvant chemotherapy for muscle-invasive bladder cancer: A single-institution experience. Cureus 17:e85071, 2025","journal-title":"Cureus"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2017.12.062"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02051"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(23)00587-9"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-1760317"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.53.2465"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26675"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17020258"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.34.8433"},{"key":"e_1_3_6_15_2","unstructured":"Common terminology criteria for adverse event (CTCAE) version 5.0. https:\/\/ctep.cancer.gov\/protocoldevelopment\/electronic_applications\/docs\/ctcae_v5_quick_reference_5x7.pdf."},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.4785"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","unstructured":"Sundriyal D Kapoor M Antil P et al: Factors associated with default of treatment and Follow-Up among patients with cancer: A cross-sectional study from a lower-middle-income country. JCO Glob Oncol 10.1200\/GO-24-00411","DOI":"10.1200\/GO-24-00411"}],"container-title":["JCO Global Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/GO-26-00219","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T19:59:08Z","timestamp":1787255948000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/GO-26-00219"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":16,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1200\/GO-26-00219"],"URL":"https:\/\/doi.org\/10.1200\/go-26-00219","relation":{},"ISSN":["2687-8941"],"issn-type":[{"value":"2687-8941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-28","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2600219"}}