Pemetrexed in transitional cell carcinoma of the urothelium

Currently, the four-drug combination of methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) or the two-drug combination of gemcitabine and cisplatin (GC) represents the standard of care for patients with locally advanced and metastatic transitional cell carcinoma of the urothelium. Recently, there has been a plethora of data from other chemotherapeutic regimens. Promising new agents, such as the multitargeted antifolate pemetrexed (Alimta), and new drug combinations have demonstrated increased efficacy and/or decreased toxicity compared with current regimens. Currently, data are available from three phase II studies utilizing pemetrexed or the combination of pemetrexed/gemcitabine (Gemzar) in patients with locally advanced and metastatic transitional cell carcinoma of the urothelium. Further investigation of combinations of pemetrexed and other active drugs in the treatment of patients with locally advanced and metastatic disease is warranted.