Chemotherapy in the management of bladder tumours

For patients with superficial bladder tumours intravesical treatment or prophylaxis with thiotepa, doxorubicin, mitomycin C or Bacillus Calmette-Guerin has added a useful dimension to management, although the precise indications for each regimen remain to be better defined. For patients with metastatic bladder cancer cisplatin and methotrexate (amethopterin), and to a lesser extent vinblastine and doxorubicin, are active single agents. Combinations of cisplatin and doxorubicin (adriamycin), and cisplatin and methotrexate +/- vinblastine +/- doxorubicin appear to induce complete remission in 20 to 35% of cases and partial remission in an additional 20 to 40% of cases. In some patients, complete remission has persisted from 2 to more than 10 years. Few randomised Phase III studies have been carried out to determine the relative effectiveness of different drug combinations, but the results of Phase II trials have encouraged investigations of adjuvant and neoadjuvant programmes combining such regimens with radiation or surgery, or both, in patients with clinically localised muscle infiltrating tumours.