Deaza-
aminopterin is a
folate analog which is transported more rapidly than
methotrexate into cells and appears to be more active than
methotrexate against human and animal
tumor in vitro. Fifteen patients with advanced urothelial tract
cancer were given deaza-
aminopterin 30-37.5 mg/m2 IV QW. In responding patients
drug was given QOW after 4-6 consecutive doses. Doses were escalated or de-escalated by 7.5 mg/m2 depending on toxicity. Twelve patients had received prior
chemotherapy which included
methotrexate in nine. Three patients achieved a partial remission lasting 1, 3, and 3 months respectively: all responders had previously failed
methotrexate after an initial response to a
methotrexate containing regimen. None of the six patients who were
methotrexate naive responded to deaza-
aminopterin; 3 subsequently received
methotrexate without response. Mild
mucositis was universal and in 5 was severe. Six patients had an increase in liver
transaminases probably secondary to anti-
folate hepatotoxicity. Other toxicities included
diarrhea,
nausea,
skin rash and
fever. Further studies are needed to define the precise efficacy of deaza-
aminopterin in patients with urothelial tract
cancers.