Gemcitabine and paclitaxel combination therapy in transitional cell carcinoma of the urothelium

Transitional cell carcinoma (TCC) of the urothelium is considered a chemosensitive malignancy; however, few patients receiving standard therapies achieve long-term disease control. Thus, new treatment approaches using more effective and less toxic agents are needed to improve prognosis in these patients. Two new agents currently being studied are gemcitabine and the taxanes; both of which have produced overall response rates ranging from 22.5 to 28% (gemcitabine), and 7-56% (paclitaxel) when used as single agents in this disease. Both agents have been well tolerated. Results of two phase II studies of gemcitabine combined with paclitaxel have been published. In one, 60% (15/25) of evaluable patients with advanced stage IV TCC responded; in the other, 53% (8/15) of patients with advanced and/or metastatic TCC responded. Several trials evaluating different dosing regimens of gemcitabine plus paclitaxel or docetaxel are ongoing or planned.