This review shows that a significant proportion of patients in curative-intent clinical trials experience toxicities that result in dose modifications-dose reduction , dose delays or missed doses-despite strict selection criteria and intense monitoring .
Toxicities of systemic cancer therapies are often less frequently observed in clinical trials than in clinical practice , due to the careful selection of patients with fewer comorbidities .
Although guidelines exist for the estimation of chemotherapy dose , clinical factors like age , comorbid illness and extremes of body habitus are not considered in the method of dose calculation , which can result in significant toxicity .
Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (AMVAC) as neoadjuvant chemotherapy for patients with muscle‐invasive transitional cell carcinoma of the bladder
Meta‐ analysis data demonstrate a 5 % absolute survival benefit for neoadjuvant chemotherapy ( NAC ) using cisplatin‐based combination regimens in the radical treatment of muscle‐invasive bladder cancer ( MIBC ) . However , there are no r and omized , controlled trial data on the optimum regimen . Accelerated methotrexate , vinblastine , doxorubicin , and cisplatin ( AMVAC ) is a dose‐intense regimen that has the potential to minimize delays to definitive , potentially curative therapy . A retrospective analysis is presented of the efficacy and toxicity  of AMVAC as NAC in patients with MIBC and its impact on the patient pathway
This review shows that a significant proportion of patients in curative-intent clinical trials experience toxicities that result in dose modifications-dose reduction , dose delays or missed doses-despite strict selection criteria and intense monitoring .
Toxicities of systemic cancer therapies are often less frequently observed in clinical trials than in clinical practice , due to the careful selection of patients with fewer comorbidities .
Although guidelines exist for the estimation of chemotherapy dose , clinical factors like age , comorbid illness and extremes of body habitus are not considered in the method of dose calculation , which can result in significant toxicity .