Chemotherapy in Metastatic Urothelial Cancer: Current and Future Treatment Options

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For more than a decade, the cisplatin plus doxorubicin and methotrexate plus vinblastine (MVAC) regimen has been the gold standard chemotherapy in bladder cancer, although the toxicity associated with this therapy has hampered its use in many older patients with metastatic disease. In recent years, new active agents have been identified, combinations of new agents with established drugs followed and results have become available on the combination of gemcitabine and cisplatin vs MVAC that have revealed an efficacy-toxicity profile in favor of the gemcitabine-cisplatin regimen. Other new doublet and triplet combinations, comprising new agents as well as incorporating one or two new agents into established regimens have demonstrated significant activity in phase II studies. However, there are no randomized data to show that any of these regimens improves patient survival as compared with either MVAC or cisplatin-gemcitabine. Advances in the understanding of the molecular biology of urothelial cancer will help to identify new biochemical targets for the development of novel therapeutic approaches to treat this cancer.

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