Gemcitabine/paclitaxel-based three-drug regimens in advanced urothelial cancer

Transitional cell carcinoma (TCC) of the urothelium is a highly chemosensit ive tumour. Combination chemotherapy can provide both palliation and a mode st survival advantage in patients with advanced disease. At present, the co mbination of cisplatin, methotrexate, doxorubicin and vinblastine (M-VAC) i s the most widely used for advanced TCC with an overall response rate of 40 -72% in phase II, and 35-45% in phase III studies, and a median survival of approximately 12 months. These modest results and the unsuccessful attempt s to increase efficacy with dose intensive M-VAC schedules have prompted th e identification of new active agents in TCC, such as the taxanes and gemci tabine. The overall response rates for two-drug regimens of cisplatin-pacli taxel, carboplatin-paclitaxel and cisplatin-gemcitabine range from 63 to 72 %, 14 to 65% and 42 to 66%, respectively. The overall response rates for pl atinum-paclitaxel-gemcitabine three-drug regimens range from 58 to 80%. The potential clinical benefit of these new three-drug combinations in the tre atment of TCC needs to be tested in future phase III studies. (C) 2000 Else vier Science Ltd. All rights reserved.