[Metastases from urethelial carcinoma: role of chemotherapy]

Chemotherapy is the first line treatment for metastatic urothelial carcinoma. Cytotoxic drugs, in particular cisplatin-based, play an important role in the first line treatment of metastatic patients. Since the 80's, no drug association has done better than M-VAC (methotrexate, vinblastin, adriamycin et cisplatin) in terms of response rate and 5-year survival rate. The Gemcitabin-Cisplatin (GC) association gives less side effects with similar results. The use of G-CSF (granulocyte/colony stimulating factor) with M-VAC has led to propose a new schedule with dose intensification and better tolerance: M-VAC-HD. In 2008, GC and M-VAC-HD are the two recommended drug associations. Unfortunately, some patients cannot be treated with these toxic drugs, in particular because of Cisplatin toxicity for kidney function. Therefore it is important to continue research to improve tolerance and anti-tumoral efficacy. After failure of first line therapy no consensual drugs exist in the second line, ongoing trials and new agents should increase options in the future.