Paclitaxel and carboplatin in patients with metastatic transitional cell cancer of the urinary tract

Objectives. The combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) is currently considered the most effective chemotherapy fo r metastatic transitional cell cancer (TCC) of the urinary tract, but becau se of its considerable toxicity, alternative regimens appear very interesti ng. We evaluated the efficacy and toxicity of a combination of paclitaxel a nd carboplatin as first-line therapy for metastatic TCC. Methods. Thirty-two patients (8 women, 24 men; mean age 67.03 years, range 50 to 79) with metastatic TCC of the bladder or upper urinary tract were in cluded in the study. Paclitaxel (175 mg/m(2)) was given as a 3-hour intrave nous infusion, carboplatin was dosed to an area under the plasma concentrat ion curve of 5 mg/mL/min calculated according to the Calvert formula [(crea tinine clearance + 25) x 5] as a 30-minute intravenous infusion immediately after paclitaxel. Response evaluation was performed after every 2 cycles a nd additional therapy depended on response. The maximum number of cycles wa s 6. Results. With a mean follow-up of 13.1 months (range 2 to 28), 23 of 32 pat ients responded to treatment (response rate 71.9%), with 31.3% complete rem ission (CR) (10 of 32) and 40.6% partial remission (PR) (13 of 32). Four pa tients (12.5%) had stable disease, and 5 patients (15.6%) showed progressio n. These results compare well with the outcome after MVAC. Toxicity was mai nly characterized by neurotoxicity grade 3 and 4 in 9.4%, grade 3 and 4 leu kopenia in 37.5%, and grade 3 thrombocytopenia in 3.1% of the patients. No nephrotoxicity was observed, but all patients developed alopecia. Time to p rogression after CR was a mean of 7.0 months (range 4 to 13) and after PR a mean of 5.9 months (range 2 to 9). Conclusions. Paclitaxel/carboplatin is an effective therapy for metastatic TCC, with low toxicity. (C) 1999, Elsevier Science Inc. All rights reserved .