title: Is there standard chemotherapy for metastatic bladder cancer? Quality of life and medical resources utilization based on largest to date randomized trial.
abstract: A large multinational phase III trial performed during the late 1990s compared two systemic chemotherapy regimens gemcitabine plus cisplatin and methotrexate, vinblastine, doxorubicin, cisplatin (M-VAC) in more than 400 patients with advanced or metastatic urothelial cancer. This trial has been discussed to landmark the beginning of a new era following M-VAC polychemotherapy which has dominated treatment of advanced urothelial cancer throughout the previous decade. Despite the fact that gemcitabine/cisplatin combination therapy did not surpass M-VAC therapy in regard to patient survival as initially intended, this combination demonstrated a more favourable toxicity profile with improved tolerability and superior cost effectiveness, rendering this combination an attractive alternative to M-VAC. This review on the largest to date phase III trial for advanced or metastatic urothelial cancer will focus on issues of quality of life including indicators such as performance status and changes in body weight. Furthermore, data on medical resources utilization as accounted during systemic polychemotherapy and related toxic events will be reconsidered, particularly under the impression of decreasing health care resources worldwide.
authors.affiliation: Department of Urology and Pediatric Urology, Saarland University, Kirrberger Strasse, 66421 Homburg/Saar, Germany. jan.lehmann@uniklinik-saarland.de
authors.forename: Jan
authors.initials: J
authors.lastname: Lehmann
authors.forename: Margitta
authors.initials: M
authors.lastname: Retz
authors.forename: Michael
authors.initials: M
authors.lastname: Stöckle
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use* / Q000633:toxicity; D002985:Clinical Protocols; D006801:Humans; D009362:Neoplasm Metastasis / Q000188:drug therapy; D011788:Quality of Life; D040841:Resource Allocation; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents