Neoadjuvant chemotherapy for stage II, III and non-metastatic stage IV cancer

MVAC
Methotrexate (MTX) 30 mg/m2 iv d1, 15 and 22
Vinblastine 3 mg/m2 iv d2, 15 and 22
Doxorubicin (Adriamycin) 30 mg/m2 iv d2
Cisplatin (CDDP) 70 mg/m2 iv d2
Q4w x 3 cycles

Grossman HB et al. Neuadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Eng J Med 2003; 349:859 (link to the article).

 
Concurrent chemoradiation for stage II, III and non-metastatic stage IV cancer

Cisplatin + RT
Cisplatin (CDDP) 100 mg/m2 iv d1 and 22
Concurrent radiotherapy 39.6 Gy
If in CR, one additional cycle of cisplatin 100 mg/m2 iv and additional concurrent radiotherapy 25.2 Gy to a total of 64.8 Gy
If no in CR, cystectomy

Shipley, WU  et al. Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: Initial results of Radiation Therapy Oncology Group 89-03. J Clin Oncol 1998; 16:3576 (link to the article).

 
Chemotherapy for metastatic cancer (back to top)

MVAC
Methotrexate (MTX) 30 mg/m2 iv d1, 15 and 22
Vinblastine 3 mg/m2 iv d2, 15 and 22
Doxorubicin (Adriamycin) 30 mg/m2 iv d2
Cisplatin (CDDP) 70 mg/m2 iv d2
Q4w x 6 cycles

Han KS et al. Methotrexate, vinblastine, doxorubicin and cisplatin combination regimen as salvage chemotherapy for patients with advanced or metastatic transitional cell carcinoma after failure of gemcitabine and cisplatin chemotherapy. Br J Cancer 2008; 98:86 (link to the article). 

Logothetis CJ et al. A prospective randomized trial comparing MVAC with CISCA chemotherapy for patients with metastatic urothelial tumors. J Clin Oncol 1990; 8:1050 (link to the article).

Gemcitabine + Cisplatin
Gemcitabine (Gemzar) 1000 mg/m2 iv over 30-60 min d1, 8 and 15
Cisplatin (CDDP) 70 mg/m2 iv d2
Q4w x 6 cycles

von der Maase H et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000; 18:3068 (link to the article). 

Carboplatin + Paclitaxel
Carboplatin (Paraplatin) AUC 6 iv d1
Paclitaxel (Taxol) 225 mg/m2 iv over 3 hrs d1
Q3w x 6 cycles

Vaughn DJ et al. Phase II study of paclitaxel plus carboplatin in patients with advanced carcinoma of the urothelium and renal dysfunction (E2896). A trial of Eastern Oncology Group. Cancer 2002; 95:1022 (link to the article)
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Gemcitabine + Paclitaxel
Gemcitabine (Gemzar) 1000 mg/m2 iv d1, 8 and 15
Paclitaxel (Taxol) 200 mg/m2 iv over 3 hrs d1
Q3w x 6 cycles

Meluch AA et al. Paclitaxel and gemcitabine chemotherapy for advanced transitional-cell carcinoma of the urothelial tract: a phase II trial of the Minnie pearl cancer research network. J Clin Oncol 2001; 19:3018 (link to the article).

Gemcitabine + Cisplatin + Paclitaxel
Gemcitabine (Gemzar) 1000 mg/m2 iv over 30-60 min d1, 8
Cisplatin (CDDP) 70 mg/m2 iv d1
Paclitaxel (Taxol) 80 mg/m2 iv d1, 8
Q3w x 6 cycles

Bellmunt J et al. Randomized phase III study comparing paclitaxel/cisplatin/gemcitabine (PCG) and gemcitabine/cisplatin (GC) in patients with locally advanced (LA) or metastatic (M) urothelial cancer without prior systemic therapy: EORTC30987/Intergroup study. 2007 ASCO annual meeting. Abstract LBA5030 (link to the abstract). 

Pemetrexed
Pemetrexed (Alimta) 500 mg/m2 iv over 10 min q3w untill disease progression

Start vitamin supplements 1 week before initial dose of pemetrexed until 21 days after last dose of pemetrexed. Folic acid 350-1000 mcg po qd. Vitamin B12 1000 mcg I.M. every 9 weeks.

Dexamethasone 4 mg twice daily the day before, the day of and the day after pemetrexed

Sweeney CJ et al. Phase II study of pemetrexed for second-line treatment of transitional cell cancer of the urothelium. J Clin Oncol 2006; 24:3451 (link to the article).