Chemotherapy of advanced transitional-cell carcinoma of the bladder.

A number of single agents and multidrug combinations are useful in the therapy of advanced transitional-cell carcinoma of the bladder. Phase II studies have identified cisplatin, Adriamycin (doxorubicin), methotrexate, and vinblastine as the most active cytotoxic agents. Combination chemotherapy based on cisplatin has shown greater efficacy than older regimens based on Adriamycin or methotrexate. Trials of regimens containing both cisplatin and methotrexate, such as those conducted by the Northern California Oncology Group using CMV (cisplatin, methotrexate, and vinblastine), have reported that a significant number of patients respond to treatment, with frequent complete responses being noted. Anthracycline-containing regimens such as M-VAC (methotrexate, vinblastine, Adriamycin, and cisplatin) have also played an important role in the therapy of advanced bladder cancer. Trials comparing cisplatin- and methotrexate-containing regimens with single-agent cisplatin or other cisplatin combinations have shown the apparent superiority of the former in terms of greater overall response rates and improved survival. However, the toxicity of such regimens can be significant, and phase III studies are under way to validate their use in the neoadjuvant setting.