CMV

CMV is the name of a chemotherapy combination. It includes the drugs:

  • C – cisplatin
  • M – methotrexate
  • V – vinblastine

It is a treatment for bladder cancer. 

How it works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have it

You have CMV drugs into your bloodstream (intravenously).

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

You usually have CMV as cycles of treatment. Each cycle lasts 3 weeks. You can have between 2-6 cycles depending on the stage of your cancer.

Day 1
  • vinblastine as a drip into your bloodstream (intravenously)
  • methotrexate as an injection into your bloodstream (intravenously)
Day 2
  • cisplatin as a drip into your bloodstream (intravenously)
Day 8
  • vinblastine as a drip into your bloodstream (intravenously)
  • methotrexate as an injection into your bloodstream (intravenously)

You then have a 2 week break before the next cycle begins.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

An increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Changes to the level of minerals in the blood

You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Inflammation of the mouth and throat causing sores and ulcers

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges, lemons and grapefruits, and chew gum to keep the mouth moist. Tell your doctor or nurse if you have ulcers.

Indigestion

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Changes to how the liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • changes to your heart rate can be a fast, slow or an irregular rate
  • inflammation and pain at the injection site
  • lung problems such as pneumonia that can cause problems with breathing. Contact your health advice line or tell your healthcare team if this happens
  • dry, irritating cough
  • chest pain
  • headaches
  • tiredness (fatigue) and drowsiness
  • diarrhoea especially in the first day or two after starting methotrexate
  • red, dry, itchy skin and or a rash

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • an allergic reaction that can be severe signs include swelling, difficulty breathing, rash and itching. Contact your advic line if you have these symptoms
  • serious skin problems causing blisters, rash, pain and peeling of the skin. Contact your health advice line or healthcare team if you have any of these symptoms.
  • a low level of magnesium in the blood causing sore muscles and cramps
  • changes to your hearing including tinnitus and loss of hearing
  • a metal taste in the mouth
  • dizziness
  • confusion and changes to mood including depression
  • fits (seizures) that might cause sudden, violent and irregular movement of the body (convulsion)
  • changes to how your brain works signs include changes to memory, attention, personality, difficulty speaking, difficulty swallowing, weakness and tiredness
  • a risk of developing another cancer called lymphoma
  • sore veins caused by inflammation
  • bleeding and ulcers in the gut (intestines) and bowels
  • an inflamed pancreas
  • an increased sensitivity of your skin to sunlight
  • hair loss
  • painless lumps under the skin
  • cold sores
  • thinning of the bones
  • sore, weak muscles
  • inflamed bladder causing pain and ulcers possibly with blood in the urine
  • pain when passing urine
  • inflammation of the vagina causing pain and ulcers

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else should I know?

Other medications, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisation

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

  • other vaccines, but they might not give you as much protection as usual
  • the flu vaccine (as an injection)
  • the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system Open a glossary item recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Related links