title: Successful treatment of metastatic urothelial carcinoma arising in a transplanted renal allograft with paclitaxel, cisplatin, and gemcitabine combination therapy: a case report.
abstract: BACKGROUND
  For locally advanced or metastatic urothelial carcinoma, cisplatin-based chemotherapy is the standard regimen. Nevertheless, almost all responding patients experience recurrence within the first year. When patients who have received prior cisplatin-based therapy become resistant, combination therapy with gemcitabine and paclitaxel has been reported. Few published case reports have addressed the utility of paclitaxel/cisplatin/gemcitabine combination therapy as second-line chemotherapy for advanced or metastatic urothelial carcinoma. This is the first report describing paclitaxel/cisplatin/gemcitabine combination therapy for metastatic urothelial carcinoma arising in a transplanted renal allograft and leading to a successful outcome.
  
  
  METHODS
  We present a case of metastatic urothelial carcinoma of a renal allograft in a 32-year-old Japanese man with a history of kidney transplantation ten years prior. Because the patient's serum creatinine increased, hemodialysis was resumed, and the surgical allograft was removed. Multiple lung metastases were resistant to gemcitabine/cisplatin adjuvant chemotherapy, so paclitaxel/cisplatin/gemcitabine combination chemotherapy was instituted. After paclitaxel/cisplatin/gemcitabine chemotherapy, all pulmonary metastatic tumors disappeared. The patient has survived without disease progression for more than four years since treatment.
  
  
  CONCLUSIONS
  Paclitaxel/cisplatin/gemcitabine combination therapy may be effective and lead to a survival advantage in patients with locally advanced or metastatic urothelial carcinoma when used as second-line chemotherapy following cisplatin-based therapy. However, further investigations may be required to confirm and evaluate the significance of this treatment.
authors: Department of Urology, Inoue Hospital, 16-17 Enoki-Cho, Suita, 564-0053, Osaka, Japan. yakojima@soryu.jp.
authors: Yasuyuki
authors: Y
authors: Kojima
authors: Department of Urology, Inoue Hospital, 16-17 Enoki-Cho, Suita, 564-0053, Osaka, Japan. takahi@soryu.jp.
authors: Yuko
authors: Y
authors: Takahi
authors: Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. ichimaru@att.med.osaka-u.ac.jp.
authors: Naotsugu
authors: N
authors: Ichimaru
authors: Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. okumi@uro.med.osaka-u.ac.jp.
authors: Masayoshi
authors: M
authors: Okumi
authors: Department of Advanced Technology for Transplantation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. takahara@att.med.osaka-u.ac.jp.
authors: Shiro
authors: S
authors: Takahara
authors: Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. nono@uro.med.osaka-u.ac.jp.
authors: Norio
authors: N
authors: Nonomura
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006417:Hematuria / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D019459:Urothelium / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D017239:Paclitaxel; D002945:Cisplatin; D000093542:Gemcitabine
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