Chemotherapy of advanced transitional cell carcinoma of the uroepithelium

Activity has been demonstrated for both single agents and combination chemotherapy in advanced transitional cell carcinoma of the uroepithelium. Regimens are palliative; duration of response has been modest, usually ranging from 3 to 8 months. There are few complete responders; occasional patients remain disease-free at 1 and 2 years. Among the single agents, cisplatin (33% response rate in 188 patients thus far reported in the literature) and methotrexate (29% response rate) are among the best studied and perhaps most active single agents. Substantial activity is also seen for cyclophosphamide (31%), doxorubicin (23%), 5-fluorouracil (35%), and mitomycin C (21%). VM-26 and vincristine appear to have activity, but relatively few patients have been treated. Response rates to combination chemotherapy, including cisplatin + doxorubicin, cisplatin + cyclophosphamide, and cisplatin + doxorubicin + cyclophosphamide, have ranged from 12% to 78%. Non-platinum-based combination regimens have also been studied, with response rates ranging from 14% to 50%. The large number of active agents, together with the occasional occurrence of a relatively durable complete response, raises hopes that more active combinations will be found and that the current surgical adjuvant trials will be positive in this disease.