title: Cisplatin, ifosfamide, methotrexate and vinblastine combination chemotherapy for metastatic urothelial cancer.
abstract: OBJECTIVE
  We investigated the activity of combination chemotherapy consisting of cisplatin, ifosfamide, methotrexate and vinblastine in patients with metastatic urothelial cancer.
  
  
  METHODS
  A total of 32 consecutive patients was treated with 30 mg./m.2 cisplatin on days 1 through 3, 1.5 gm./m.2 ifosfamide with mesna on days 1 through 3, 30 mg./m.2 methotrexate and 3 mg./m.2 vinblastine on day 1 plus 5 micrograms./kg. granulocyte colonystimulating factor on days 7 through 11. Courses were repeated every 21 days for a maximum of 6 cycles.
  
  
  RESULTS
  Major toxicity was granulocytopenia in 56% of patients, including 11 episodes of granulocytopenic fever. Anemia and thrombocytopenia developed in a third of the cases. No other significant toxicity or treatment related death was noted. An objective response was achieved in 20 patients (62.5%, 95% confidence interval 44 to 79). Median time to progression was 7 months and median survival was 13 months.
  
  
  CONCLUSIONS
  The cisplatin, ifosfamide, methotrexate and vinblastine regimen appeared active in patients with metastatic urothelial carcinoma. This regimen was associated with significant but manageable hematological toxicity and the incidence of mucositis or renal impairment was low. Prospective randomized studies are needed to assess whether the addition of ifosfamide to other active agents will improve the survival of patients with this disease.
authors.affiliation: Department of Urology, University of Athens School of Medicine, Greece.
authors.forename: Z
authors.initials: Z
authors.lastname: Kyriakakis
authors.forename: M A
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: A
authors.initials: A
authors.lastname: Kostakopoulos
authors.forename: A
authors.initials: A
authors.lastname: Karayiannis
authors.forename: F
authors.initials: F
authors.lastname: Sofras
authors.forename: A
authors.initials: A
authors.lastname: Zervas
authors.forename: A
authors.initials: A
authors.lastname: Giannopoulos
authors.forename: C
authors.initials: C
authors.lastname: Dimopoulos
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D009362:Neoplasm Metastasis; D015996:Survival Rate; D014516:Ureteral Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D000964:Antimetabolites, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D000972:Antineoplastic Agents, Phytogenic; D014747:Vinblastine; D007069:Ifosfamide; D008727:Methotrexate