Review and outlook for the role of paclitaxel in urothelial carcinoma.

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) is an active agent in the treatment of patients with advanced urothelial carcinoma. The lack of nephrotoxicity and the ability to administer this agent to select patients with renal insufficiency provide potential advantages over the standard cisplatin-based regimens in this patient population. Paclitaxel-based combination regimens have recently been developed and reported. Paclitaxel plus carboplatin is an active and tolerable outpatient regimen for patients with advanced urothelial cancer. Ongoing cooperative group trials will help to further define the activity and toxicity of this regimen in previously untreated patients, patients with prior treatment, and patients with abnormal renal function. A cooperative group trial will compare paclitaxel plus carboplatin with the cisplatin-based regimen cisplatin/ methotrexate/vinblastine/doxorubicin (MVAC). The role of paclitaxel in the early disease and combined-modality settings in urothelial cancer remains to be determined.