A study of cyclophosphamide, adriamycin, cis-platinum, and methotrexate in advanced transitional cell carcinoma of the urinary tract.

Twenty patients with locally advanced and/or metastatic transitional cell cancer of the urinary tract were treated with cyclophosphamide 500 mg/m2, Adriamycin (doxorubicin) 40 mg/m2 and cis-platinum (CDDP) 40 mg/m2 given every three weeks for 2 cycles, alternating with methotrexate 40 mg/m2 weekly for six weeks (CAP-M). Five of thirteen (38%) evaluable patients responded, with a significant prolongation of survival. Toxicity in 18 evaluable patients was mild to moderate. Methotrexate can be combined with CAP with significant reduction in dosage of cyclophosphamide, Adriamycin and CDDP and reduced toxicity, without major loss of efficacy. The precise role of methotrexate in combination chemotherapy of bladder cancer remains to be defined.