[New developments in chemotherapy for metastasized bladder cancer]

Methotrexate vinblastine doxorubicin cisplatin (MVAC) has been the golden standard in the chemotherapy of metastasized bladder cancer for more than ten years. This regimen is particularly suitable for fit patients (WHO performance status 0 or 1) with a good renal function. This leads to an overall response in 40-57% of the patients and to a complete response in 13-19%. The median survival is about 15 months. Combination chemotherapy consisting of cisplatin and gemcitabine (GC) is a valuable alternative with a comparable effectiveness, but with the advantage of clearly less toxicity (neutropenic fever, mucositis, sepsis and mortality). The extra value of adding paclitaxel to this GC combination to improve the survival of this fit group of patients is currently being investigated. The value of the combination carboplatin-gemcitabine versus carboplatin-methotrexate-vinblastine as a palliative regimen with a favourable toxicity profile for the less fit patients is also currently under investigation.