Progress in the Management of Metastatic Bladder Cancer

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Abstract
Background: Inadequate survival results from single agents in the management of advanced bladder cancer have prompted several trials involving multidrug combinations to increase response rates and survival. Methods: Since the development of the MVAC regimen (methotrexate, vinblastine, doxorubicin, and cisplatin) and the CMV regimen (cisplatin, methotrexate, and vinblastine), other regimens have been tested. We evaluate results from regimens that include cisplatin combined with gemcitabine, paclitaxel, or docetaxel, and paclitaxel combined with gemcitabine or carboplatin. Results: Objective results observed with various new combinations are promising. Objective response (OR) rates of 41%, 59%, and 71% are reported with a regimen of gemcitabine plus cisplatin. Paclitaxel plus cisplatin produced OR rates of 65% and 72%. Conclusions: The use of combination cytotoxic chemotherapy regimens in treating patients with metastatic bladder cancer has nearly doubled median survival to 12 months, with a 3-year survival of approximately 20% to 25%. Caution must be exercised in using some of the newer regimens as survival may be inferior compared with the MVAC regimen.