Results of combination chemotherapy in advanced urothelial cancer

Between April 1982 and March 1988, 28 patients with advanced urothelial cancer were treated with combination chemotherapy incorporating cisplatin at our hospital and the response was evaluated. Fourteen of them were managed by the CAP chemotherapy (cyclophosphamide 300-500 mg/m2 day 1, doxorubicin 30-50 mg/m2 day 1, cisplatin 40-90 mg/m2 day 2), 7 by the FAP chemotherapy (fluorouracil 300 mg/m2 day 1-5, doxorubicin 30 mg/m2 day 1, cisplatin 15 mg/m2 day 1-5) and 7 by the MEP chemotherapy (etoposide 100 mg/m2 day 1-3, cisplatin 20 mg/m2 day 1-5, methotrexate 300 mg/body day 6). Four patients (28.6%) responded to the CAP regimen; a complete response was gained in one patient who had pulmonary metastasis of excised ureteral cancer and a partial response in 3 patients with intravesical and nodal (N3, N4) cancer. A partial response was noted in 3 patients (42.9%) in the FAP group. They had intravesical lesions and two of them had regional node metastasis (N3). A higher response rate (85.7%) was obtained by the MEP regimen; a complete response in 2, who had intravesical and nodal (N2, N4) cancer, and a partial response in 4 patients, 1 had intravesical cancer, 1 had nodal (N2) and intravesical cancer and 2 had nodal or lung metastasis of excised renal pelvic cancer. Toxicity included mild to severe vomiting, alopecia, myelosuppression and mild renal or liver dysfunction. High dose metoclopramide provided a high degree of protection against cisplatin induced emesis. The results with the MEP regimen are promising for the advanced, metastatic urothelial cancer.