Cancer Treatment Today

Although advanced urothelial carcinoma is a common and relatively chemosensitive neoplasm, it still remains a fatal disease. Over the last 10 years or so chemotherapy of advanced urothelial tumours has focused on cisplatin-based combinations such as cisplatin-methotrexate-vinblastine (CMV), or methotrexate-vinblastine-adriamycin-cisplatin (M-VAC). Response rates with standard cisplatin-based combination chemotherapy range from 40 to 70%; however, approximately 50% of all patients will develop metastasis, and recent studies indicate that the disease-free long-term (5-year) survival rate is only about 4%. Standard therapy with M-VAC offers a moderate median survival of 1 year; however, it is achieved at the expense of major toxicities, including myelosuppression, nausea, vomiting and nephrotoxicity that often limit its use to patients with normal renal function and adequate performance status. A recent phase III study has indicated that the combination of gemcitabine/cisplatin could replace the standard of care M-VAC since the efficacy was similar in the two regimens with respect to response, time to progressive disease and overall survival; however, toxicity was significantly less in the gemcitabine/cisplatin arm.
There are several pahse II studies of Taxotere/Gemzar with reasonable results. A randomized pahse II study comparing this combination with gemcitabine/cisplatin found a basic equivolence etween the two arms.

D. Pectasides+, J. Glotsos, N. Bountouroglou, A. Kouloubinis, N. Mitakidis, N. Karvounis, N. Ziras and A. Athanassiou Weekly chemotherapy with docetaxel, gemcitabine and cisplatin in advanced transitional cell urothelial cancer: a phase II trial Annals of Oncology 13:243-250, 2002

http://www.lillytrials.com/results_files/gemzar/gemzar_summary_4087.pdf, reported in Proceedings of ASCO 2003;22:390. abs. 1568

A Ardavanis, Gemcitabine and docetaxel as first-line treatment for advanced urothelial carcinoma: a phase II study, British Journal of Cancer (2005) 92, 645-650.