The combination of methotrexate, vinblastine, doxorubicin, and cisplatin (M
VAC) has become the standard of care for metastatic urothelial cancer. Its
efficacy has been proven in this setting but it can be a difficult regimen
to tolerate. With the introduction of new active agents, different combinat
ions are being evaluated. This article will highlight the use of these new
regimens with emphasis on those employing gemcitabine or the taxanes.