Cisplatin and medium dose methotrexate in advanced transitional cell carcinoma of the urinary tract

Twenty-seven patients with advanced transitional cell carcinoma of the urothelium were studied. The area of each tumour was measured by computed tomography. Twenty-four of the 27 patients were evaluated after treatment with the following course of chemotherapy given intravenously: day 1-cisplatin 50 mg/m2; day 2-methotrexate 250 mg/m2; and folinic acid rescue treatment 24 hours after the methotrexate infusion. Each cycle of treatment was given three times, with two weeks between cycles. There were two complete and 11 partial responses, and the primary tumour responded as often as the distant metastases. The toxicity of the regimen was acceptable, even given the advanced age of most of the patients. Most of whom found that their disturbances of micturition and sleeping problems were improved by the treatment. Cisplatin combined with methotrexate achieves a response rate of about 50% in advanced transitional cell carcinoma. When combinations of chemotherapy are being chosen for these often elderly patients the curability and palliation effects must be balanced against the toxicity and morbidity.