CISPLATIN, IFOSFAMIDE, METHOTREXATE AND VINBLASTINE COMBINATION CHEMOTHERAPY FOR METASTATIC UROTHELIAL CANCER

Purpose: We investigated the activity of combination chemotherapy cons isting of cisplatin, ifosfamide, methotrexate and vinblastine in patie nts with metastatic urothelial cancer. Materials and Methods: A total of 32 consecutive patients was treated with 30 mg./m.(2) cisplatin on days 1 through 3, 1.5 gm./m.(2) ifosfamide with mesna on days 1 throug h 3, 30 mg./m.(2) methotrexate and 3 mg./m.(2) vinblastine on day 1 pl us 5 mu g./kg. granulocyte colony-stimulating factor on days 7 through 11. Courses were repeated every 21 days for a maximum of 6 cycles. Re sults: Major toxicity was granulocytopenia in 56% of patients, includi ng 11 episodes of granulocytopenic fever. Anemia and thrombocytopenia developed in a third of the cases. No other significant toxicity or tr eatment related death was noted. An objective response was achieved in 20 patients (62.5%, 95% confidence interval 44 to 79). Median time to progression was 7 months and median survival was 13 months. Conclusio ns: The cisplatin, ifosfamide, methotrexate and vinblastine regimen ap peared active in patients with metastatic urothelial carcinoma. This r egimen was associated with significant but manageable hematological to xicity and the incidence of mucositis or renal impairment was low. Pro spective randomized studies are needed to assess whether the addition of ifosfamide to other active agents will improve the survival of pati ents with this disease.