Recurrent or metastatic bladder cancer: two vs. three drugs
In this kind of a situation, NCCN recommends chemotherapy and/or radiation. The regimens that it recommends on BL-G1 are DDMVAC,gemcitabine and cisplatin or CMV. For first line chemotherapy for metastatic disease, which this canl legitmately be considered to be, it recommend gemcitaibne nan cisplaitn, DDMVAC or “carboplatin or taxane regimens, or single agent chemotherapy”. It says specifically: “For most patients, the risk of adding paclitaxel to gemcitabine and cisplatin outweigh the limited benefit seen in a randomized trial”.
NCCN, Bladder Cacner, BL-G 1-4, 2016
Bellmunt J, von der Maase H, Mead GM, Skoneczna I, De Santis M, Daugaard G, Boehle A, Chevreau C, Paz-Ares L, Laufman LR, Winquist E, Raghavan D, Marreaud S, Collette S, Sylvester R, de Wit R.Randomized phase III study comparing paclitaxel/cisplatin/gemcitabine and gemcitabine/cisplatin in patients with locally advanced or metastatic urothelial cancer without prior systemic therapy: EORTC Intergroup Study 30987. J Clin Oncol. 2012 Apr 1;30(10):1107-13.