Table 132, GRADE evidence profile: MVAC versus M-CAVI (Methotrexate, Carboplatin, Vinblastine) - Bladder Cancer

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Quality assessment							Summary of findings
Quality assessment							No of patients		Effect		Quality
No of studies	Design	Limitations	Inconsistency	Indirectness	Imprecision	Other considerations	MVAC	M-CAVI	Relative (95% CI)	Absolute	Quality
Overall survival (disease-related mortality rate, follow-up median 18 months, range 6-60 months)
1¹	randomised trials	none	none	none	very serious²	none	19/24 (79.2%)	18/23 (78.3%)	HR 0.49 (0.26 to 0.93)	Median DSS, 16 vs. 9 months³	⊕⊕○○ LOW
Progression-free survival
0	no evidence available
Toxicity - Grade 3-4 Stomatitis
1¹	randomised trials	none	none	none	very serious²	none	5/24 (20.8%)	1/23 (4.3%)	RR 4.79 (0.6 to 37.95)	165 more per 1000 (from 17 fewer to 1000 more)	⊕⊕○○ LOW
Toxicity - Grade 3-4 Thrombocytopenia
1¹	randomised trials	none	none	none	very serious²	none	1/24 (4.2%)	1/23 (4.3%)	RR 0.96 (0.06 to 14.43)	2 fewer per 1000 (from 41 fewer to 584 more)	⊕⊕○○ LOW
Toxicity - Grade 3-4 Anaemia
1¹	randomised trials	none	none	none	very serious²	none	1/24 (4.2%)	1/23 (4.3%)	RR 0.96 (0.06 to 14.43)	2 fewer per 1000 (from 41 fewer to 584 more)	⊕⊕○○ LOW
Treatment-related mortality
1¹	randomised trials	none	none	none	very serious²	none	1/24 (4.2%)	0/23 (0%)	RR 2.88 (0.12 to 67.29)	-	⊕⊕○○ LOW
Health-related quality of life
0	no evidence available

1: Bellmunt (1997);
2: Low number of participants/events and wide confidence intervals limits the precision of this outcome. HR calculated from p-value and observed number of events.
3: Median disease-related survival was 16 months (range 3 to 24+) for MVAC, and 9 months (range 2 to 17) for M-CAVI ( p= 0.03).

Bladder Cancer: Diagnosis and Management.

NICE Guideline, No. 2.

National Collaborating Centre for Cancer (UK).

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