Between April 1982 and March 1988, 28 patients with advanced urothelial
cancer were treated with
combination chemotherapy incorporating
cisplatin at our hospital and the response was evaluated. Fourteen of them were managed by the CAP
chemotherapy (
cyclophosphamide 300-500 mg/m2 day 1,
doxorubicin 30-50 mg/m2 day 1,
cisplatin 40-90 mg/m2 day 2), 7 by the FAP
chemotherapy (
fluorouracil 300 mg/m2 day 1-5,
doxorubicin 30 mg/m2 day 1,
cisplatin 15 mg/m2 day 1-5) and 7 by the MEP
chemotherapy (
etoposide 100 mg/m2 day 1-3,
cisplatin 20 mg/m2 day 1-5,
methotrexate 300 mg/body day 6). Four patients (28.6%) responded to the CAP regimen; a complete response was gained in one patient who had pulmonary
metastasis of excised
ureteral cancer and a partial response in 3 patients with intravesical and nodal (N3, N4)
cancer. A partial response was noted in 3 patients (42.9%) in the FAP group. They had intravesical lesions and two of them had regional node
metastasis (N3). A higher response rate (85.7%) was obtained by the
MEP regimen; a complete response in 2, who had intravesical and nodal (N2, N4)
cancer, and a partial response in 4 patients, 1 had intravesical
cancer, 1 had nodal (N2) and intravesical
cancer and 2 had nodal or lung
metastasis of excised renal
pelvic cancer. Toxicity included mild to severe
vomiting,
alopecia, myelosuppression and mild renal or
liver dysfunction. High dose
metoclopramide provided a high degree of protection against
cisplatin induced
emesis. The results with the
MEP regimen are promising for the advanced, metastatic urothelial
cancer.