[Chemotherapy of bladder carcinoma. Current status and trends]

Cisplatin and methotrexate are the most effective single agents used in the chemotherapy of metastatic transitional cell carcinoma. These agents should be included in polychemotherapy regimens. Polychemotherapy, especially with MVAC, leads to improved rates of complete remission. The attainment of complete remission has a statistically significant association with duration of survival. However, after 5 years there is no further survival advantage. If one quarter of patients achieve a CR, with a duration of more than 3 years in only half of them, a durable response can be expected in only 13% of treated patients. That means a maximal therapeutic benefit of 10-15% in polychemotherapy of bladder cancer, which is associated with relatively high toxicity. Prospective randomized trials are needed to determine the efficacy of treatment with two versus four agents. Dose intensification of the agents in the MVAC regimen has not resulted in significant improved remission rates. This approach is also limited by the appearance of non-haematotoxic side effects.