[The role of new drugs in the treatment of locally advanced urothelial tumors of the bladder].
Although the optimal management of muscle-invasive bladder cancer remains a continued subset of controversy, results achieved with either radical cystectomy, or radiation therapy or combinations of the two lead to cure rates of only 50% with up to 50% of patients who will develop metastases, usually within two years. For the past ten years, chemotherapy of advanced urothelial tumors has focused on cisplatin-based combinations such as methotrexate-vinblastine-adriamycin-cisplatin (M-VAC), cisplatin-methotrexate-vinblastine (CMV) or cisplatin-adriamycin-cyclophosphamide (CISCA). Such regimens have provided interesting results with responses rate up to 70% and some long term survival (in 10 to 20% of patients), but this has focused achieved with moderate to severe toxicity. Thus, if the chemosensitivity of advanced urothelial tumors is obvious, it is clear that a therapeutic plateau has been reached and only the search for new active agents can provide any hope to improve the results of these established regimens. Recently some single agents under investigation including taxanes (paclitaxel and docétaxel) and gemcitabine have been identified and have entered clinical development. Preliminary data of several phase II studies are now available and they appear promising, providing the basis of new combinations regimens that will attempt to improve results that have been achieved with standard regimens during the past decade. The activity of these new single agents and new combination are reviewed.
Antoine
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EC
Service d'oncologie médicale, Hôpital de la Pitié-Salpêtrière, Paris, France.
Khayat
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D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077143:Docetaxel; D006801:Humans; D009361:Neoplasm Invasiveness; D017239:Paclitaxel / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D043823:Taxoids; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000093542:Gemcitabine
D000970:Antineoplastic Agents; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D017239:Paclitaxel; D000093542:Gemcitabine