The standard treatment for advanced bladder cancer is the chemotherapy combination consisting of cisplatin (Platinol®)methotrexateVelban® (vinblastine) and doxorubicin (Adriamycin®)referred to as M-VAC. HoweverM-VAC is associated with side effects and are particularly difficult to tolerate for patients who have impaired renal function and/or are elderly. Researchers have been evaluating different chemotherapy combinations for the treatment of advanced bladder cancer in patients who are not able to tolerate M-VAC. A randomized study shwoed that gemcitabine/cisplatin is as effective and much less toxic. In an attempt to fartehr reduce toxicitycarboplatin has been substituted for cisplatin. That the two drugs are very similar and carboplatin has been able to substitute for cisplatin in many tumor types.
Paclitaxel demonstrates significant single-agent activity in advanced urothelial carcinoma. A phase II trial conducted in 1994 demonstrated that paclitaxel (Taxol) was effective in locally advanced or metastatic transitional cell carcinoma of the urothelium with a complete response rate of 27%. Due to the lack of nephrotoxicityand the ability to administer Taxol to patients with renal insufficiencynew regimens could provide potential advantages over the standard cisplatin-based regimens. Paclitaxel/carboplatin is an active and tolerable outpatient chemotherapy treatment regimen for these patients. This regimen has been studied in several phase II trials with response rates ranging from 14 to 65%. Preliminary results suggest that the combination of paclitaxel and carboplatin as first-line therapy compared well with the outcome after MVACand with less toxicity. Ongoing trials are comparing paclitaxel/carboplatin with M-VAC (methotrexatevinblastinedoxorubicincisplatin) in both the advanced disease and adjuvant settings. For a multiply treated patientespecially in third lineI consider this to be an experiemtnal regimen.
Hussain MVaishampayan UDu Wet al. Combination paclitaxelcarboplatinand gemcitabine is an active treatment for advanced urothelial cancer. J Clin Oncol. 2001;19:2527.
Hussein MSmith DAl-Sukhum Set al. Preliminary results of Her-2/neu screening and treatment with trastuzumabpaclitaxelcarbplatin and gemcitabine in patients with advanced urothelial cancer. Program and abstracts of the American Society of Clinical Oncology 38th Annual Meeting; May 18-212002; OrlandoFlorida. Abstract 800.
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