Treatment of Metastatic or Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter

The prognosis for any patient with metastatic or recurrent transitional cell cancer is poor. The proper management of recurrence depends on the sites of recurrence, extent of prior therapy, and individual patient considerations. Chemotherapy regimens that have been effective for metastatic bladder cancer have generally been applied to transitional cell cancers arising from other sites. Patients with distant metastases have a poor prognosis and can be offered treatment in a clinical trial.

In patients with metastatic or recurrent transitional cell carcinoma of the bladder, combination chemotherapy has produced high response rates and occasional complete responses.[1,2] Results from a randomized trial that compared methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) with single-agent cisplatin in advanced bladder cancer showed a significant advantage with M-VAC in both response rate and median survival. The overall response rate with M-VAC in this cooperative group trial was 39%.[3]

Other chemotherapy agents that have shown activity in metastatic transitional cell cancer include the following:[4-8][Level of evidence C3]

Ifosfamide, gallium nitrate, and pemetrexed have shown limited activity in patients previously treated with cisplatin.