Three-drug combination chemotherapy for advanced urothelial tract carcinoma

A prospective chemotherapeutic trial using combinations of three drugs consisting of three different protocols was performed in 24 patients with advanced transitional-cell carcinoma of the urothelial tract between April 1981 and August 1986. All patients had histologically proven transitional-cell carcinoma and bidimensionally measurable lesions. The protocol I (PPA) was a 5-day course of treatment with 20 mg/m2 cis-platinum and 5 mg/m2 peplomycin (a derivative of bleomycin) on days 1-5, and 25 mg/m2 adriamycin on day 1. Protocol II (CFMit) was a 10-day course with 3 mg/m2 mitomycin-C and 300 mg/m2 cyclophosphamide on day 1, and 180 mg/m2 5-fluorouracil on days 1-10. Protocol III (PAM) was a 1-day course comprising 60 mg/m2 cis-platinum, 30 mg/m2 adriamycin, and 40 mg/m2 methotrexate. In protocols I and III, the drugs were administered every 4-5 weeks, while in protocol II, the drugs were administered continuously without any interval. Of the 9 patients who received 1 to 5 PPA courses, only 3 patients showed a minor response. In the 10 patients who received 4 to 44 CFMit courses, 3 (33%) achieved partial remission for 1.5-22 months, and 3 had a minor response. Of the 5 patients receiving 3 to 7 PAM courses, 1 patient achieved partial remission for 5 months, and 1 had a minor response. Myelosuppression, nausea, vomiting, and anorexia were frequently observed in each protocol. Loss of hair was often observed in protocols I and III. Stomatitis and diarrhea were observed in protocol II. Three patients in protocol I, 4 patients in protocol II, and 1 patient in protocol III were unable to tolerate more courses of the regimen due to the severe side effects.