title: Combination chemotherapy of cisplatin, methotrexate, vinblastine, and high-dose tamoxifen for transitional cell carcinoma.
abstract: BACKGROUND
  We have previously demonstrated that tamoxifen enhanced the chemosensitivity of bladder cancer cells in vitro. In this pilot study, we tested the modulating effect of high-dose tamoxifen to conventional cisplatin, methotrexate, and vinblastine combination chemotherapy (CMV-T) for transitional cell carcinoma (TCC).
  
  
  METHODS
  Between Nov. 1994 and Mar. 1999, 30 TCC patients were enrolled. Nine patients had muscle-invasive bladder TCC; 21 patients had either unresectable locally advanced diseases or distant metastases. CMV-T consisted of cisplatin 50 mg/m2/day, day 1 & 2; methotrexate 30 mg/m2/day, day 1 & 8; vinblastine 3 mg/m2/day, day 1 & 8; and tamoxifen 200 mg/m2/day, days 1 through 4.
  
  
  RESULTS
  A total of 98 courses had been given with an average of 3.27 courses per patient (range: 1-7). Grade III/IV leukopenia and thrombocytopenia occurred in 18% and 21% of total courses, respectively. There were 7 episodes of neutropenic fever, and 3 patients died of sepsis. Non-haematologic toxicities were generally mild. There was no venous thrombosis. Out of 26 patients eligible for evaluation of response, 1 complete and 14 partial responses with an overall response rate of 58% (95% confidence interval: 38-75%) were observed. The mean survival of all patients was 8 months.
  
  
  CONCLUSIONS
  The toxicity of CMV-T chemotherapy is moderate, but generally manageable. The response rate of CMV-T for patients with advanced TCC seems to be only comparable to most conventional cisplatin-based combinations. The possible benefit of tamoxifen to enhance chemosensitivity of TCC needs further investigation.
authors: Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
authors: C H
authors: CH
authors: Hsu
authors: J
authors: J
authors: Chen
authors: C Y
authors: CY
authors: Wu
authors: A L
authors: AL
authors: Cheng
authors: Y S
authors: YS
authors: Pu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D012074:Remission Induction; D018805:Sepsis / Q000209:etiology; D013629:Tamoxifen / Q000008:administration & dosage / Q000009:adverse effects; D013921:Thrombocytopenia / Q000139:chemically induced; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D013629:Tamoxifen; D014747:Vinblastine; D002945:Cisplatin; D008727:Methotrexate