~
Cancer ChemotherPharmacol(1992) 30 (Suppl):S 99-S 110
anc~r
hemotherapyand harmacology
9 Springer-Verlag1992
Chemotherapy of advanced transitional-cell carcinoma of the bladder* Robert S. Miller 1, and Frank M. Torti2 1Departmentof Medicine,Divisionof Oncolog), StanfordUniversitySchoolof Medicine,Stanford,California,USA 2VeteransAdministrationMedicalCenter,PaloAlto,California,USA
Summary. A number of single agents and multidrug combinations are useful in the therapy of advanced transitionalcell carcinoma of the bladder. Phase II studies have identified cisplatin, Adriamycin (doxorubicin), methotrexate, and vinblastine as the most active cyto:toxic agents. Combination chemotherapy based on cisplatin has shown greater efficacy than older regimens based on Adriamycin or methotrexate. Trials of regimens containing both cisplatin and methotrexate, such as those conducted by the Northern California Oncology Group using CMV (cisplatin, methotrexate, and vinblastine), have reported that a significant number of patients respond to treatment, with frequent complete responses being noted. Anthracyclinecontaining regimens such as M-VAC (methotrexate, vinblastine, Adriamycin, and cisplatin) have also played an important role in the therapy of advanced bladder cancer. Trials comparing cisplatin- and methotrexate-containing regimens with single-agent cisplatin or other cisplatin combinations have shown the apparent superiority of the former in terms of greater overall response rates and improved survival. However, the toxicity of such regimens can be significant, and phase II[ studies are under way to validate their use in the neoadjuvant setting.
Introduction According to data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, an estimated 51,600 new cases of cancer of the bladder and 9,500 deaths will have been recorded in the
* Presented at the 4th InternationalConferenceon Treatmentof Urinary Tract Tumors with Adriamycin/Farmorubicin,16-17 November 1990, Osaka, Japan R. S. Miller, SacramentoCenter for Hematology and MedicalOncology,5275 F Street, Sacramento,CA 95819, USA Correspondence to:
United States for 1992 [4]. Although >70% of cases are localized at the time of diagnosis and many remain confined to the bladder for their entire natural history, tumors that invade into the smooth muscle of the bladder wall carry a poor prognosis. Despite advances in surgical and radiotherapy techniques, there has been little change in survival rates over the past 40 years, with
Cancer ChemotherPharmacol(1992) 30 (Suppl):S 99-S 110
anc~r
hemotherapyand harmacology
9 Springer-Verlag1992
Chemotherapy of advanced transitional-cell carcinoma of the bladder* Robert S. Miller 1, and Frank M. Torti2 1Departmentof Medicine,Divisionof Oncolog), StanfordUniversitySchoolof Medicine,Stanford,California,USA 2VeteransAdministrationMedicalCenter,PaloAlto,California,USA
Summary. A number of single agents and multidrug combinations are useful in the therapy of advanced transitionalcell carcinoma of the bladder. Phase II studies have identified cisplatin, Adriamycin (doxorubicin), methotrexate, and vinblastine as the most active cyto:toxic agents. Combination chemotherapy based on cisplatin has shown greater efficacy than older regimens based on Adriamycin or methotrexate. Trials of regimens containing both cisplatin and methotrexate, such as those conducted by the Northern California Oncology Group using CMV (cisplatin, methotrexate, and vinblastine), have reported that a significant number of patients respond to treatment, with frequent complete responses being noted. Anthracyclinecontaining regimens such as M-VAC (methotrexate, vinblastine, Adriamycin, and cisplatin) have also played an important role in the therapy of advanced bladder cancer. Trials comparing cisplatin- and methotrexate-containing regimens with single-agent cisplatin or other cisplatin combinations have shown the apparent superiority of the former in terms of greater overall response rates and improved survival. However, the toxicity of such regimens can be significant, and phase II[ studies are under way to validate their use in the neoadjuvant setting.
Introduction According to data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program, an estimated 51,600 new cases of cancer of the bladder and 9,500 deaths will have been recorded in the
* Presented at the 4th InternationalConferenceon Treatmentof Urinary Tract Tumors with Adriamycin/Farmorubicin,16-17 November 1990, Osaka, Japan R. S. Miller, SacramentoCenter for Hematology and MedicalOncology,5275 F Street, Sacramento,CA 95819, USA Correspondence to:
United States for 1992 [4]. Although >70% of cases are localized at the time of diagnosis and many remain confined to the bladder for their entire natural history, tumors that invade into the smooth muscle of the bladder wall carry a poor prognosis. Despite advances in surgical and radiotherapy techniques, there has been little change in survival rates over the past 40 years, with
