[Systemic chemotherapy of urothelial carcinoma]

Systemic chemotherapy is used mainly in patients in whom metastases develop after successful local therapy. It is also used for inductive and adjuvant treatment, mostly still in clinical trials. At present cisplatin and methotrexate are the most effective drugs. Polychemotherapy protocols including cisplatin and methotrexate are more effective than those with neither of these two drugs. The complete remission rate in patients with metastatic tumors is about 10-20%. The relapse rate is about 60%. Long-lasting remissions are now being seen for the first time. A significant advantage of polychemotherapy over monochemotherapy has not been definitely proven. Inductive chemotherapy destroys locally advanced bladder tumors in about 30% of cases. It has not so for been shown whether this has a positive influence on the length of survival. Adjuvant chemotherapy has also yielded no results confirming that chemotherapy following cystectomy results in prolonged tumor-free survival. We cannot yet say whether subgroups it has not yet been possible to define will profit from it. The rate and severity of side-effects are dose-dependent, and their occurrence is determined by many factors. Especially in older patients, age-related disease has to be taken into consideration; to what extent the dose reduction needed may result in a significant lower remission rate is not known.