ADJUVANT METHOTREXATE, VINBLASTINE AND CISPLATIN CHEMOTHERAPY FOR INVASIVE TRANSITIONAL-CELL CARCINOMA - TAIWAN EXPERIENCE

Purpose: The feasibility of adjuvant cisplatin, methotrexate and vinbl astine chemotherapy was evaluated in Taiwanese patients with invasive transitional cell carcinoma at high risk for recurrence. Materials and Methods: We assigned 56 patients with high risk transitional cell car cinoma (vascular or lymphatic invasion in the primary tumor, poorly di fferentiated stage P2, P3, P4 or N+ and MO) to receive adjuvant chemot herapy after radical urological surgery. The chemotherapy consisted of 40 mg./m.(2) methotrexate and 4 mg./m.(2) vinblastine on days 1 and 8 , and 100 mg./m.(2) cisplatin on day 2 given in 6 courses at 21-day in tervals. Results: Median followup was 44 months. An average of 4.63 cy cles of chemotherapy was administered. The median actual survival was 44 months, and the 1 and 3-year survival probabilities were 92% and 50 %, respectively. The median disease-free survival was 15.5 months, and the 1 and 3-year disease-free survival probabilities were 66% and 28% , respectively. Only 5 (9%) and 1 (2%) patients had grades 3 and 4 leu kopenia, respectively, and none died of sepsis. Conclusions: The use o f adjuvant cisplatin, methotrexate and vinblastine chemotherapy in pat ients with invasive transitional cell carcinoma at high risk for recur rence is feasible with tolerable toxicity but randomized controlled tr ials will be required to assess the benefit.