COMBINATION CHEMOTHERAPY FOR ADVANCED BILHARZIAL BLADDER-CARCINOMA

Background: Carcinoma of the bilharzial bladder, the most common cance r in Egyptian patients has been, until recently, largely treated by su rgery. We have studied the activity of a series of single agents in ph ase II trials and identified a number of active agents. Here we report the results of a trial in which therapeutic combinations of the most active agents were administered in alternating cycles to patients who had never received chemotherapy. Patients and methods: The study inclu ded 30 patients with histologically proven inoperable (20), recurrent (5, 2 of whom subsequently developed metastases), or metastatic diseas e (5). There were 27 males and 3 females, with a median age of 48.5 ye ars (range 29-65 years). Fourteen patients had squamous cell carcinoma , 12 had transitional cell carcinoma, 2 had adenocarcinoma, and the re maining 2 had undifferentiated carcinoma. Chemotherapy consisted of ep idoxorubicin (120 mg/sqm i.v. d1) and vincristine (1.4 mg/sqm i.v., da ys 1 and 8) alternating with etoposide (100 mg/sqm i.v. infusion over 1 hour, days 1 to 5) and ifosfamide (1800 mg/sqm i.v. infusion over 2 hours, days 1 to 5). Mesna was given as a uroprotector at 40% of the i fosfamide dose at 0, 4, and 8 hours after the ifosfamide infusion. Cou rses were repeated every 3-4 weeks. Results: Among the 22 evaluable pa tients, 8 (36.5%) had a partial and one (4.5%), a complete response, g iving a response rate of 46%. Three more patients had responses that w ere less than a partial remission, and 6 patients showed disease stabi lisation on chemotherapy. Toxicities were tolerable and consisted main ly of myelosuppression. Results were further analysed in relation to p athologic subtype, disease status at the start of chemotherapy, and th e delivered dose intensity. No relationship was found between any of t hese parameters and response to therapy. Conclusion: Advanced bilharzi al bladder cancer is relatively sensitive to combination chemotherapy, but complete remission and prolonged survival is rare in this subgrou p of patients with advanced disease. Further studies will be needed to determine the relative efficacy of single agents and drug combination s.