Jackson Appointed Chief

Between May 1986 and September 1990 a total of 43 patients with metastatic transitional cell carcinoma (TCC) of the urinary tract have been treated at our institution with combination chemotherapy (CMV) consisting of cisplatin 100mg m2 IV day 2; methotrexate 30mg m2 IV days 1,8; and vinblastine 4 mg m-2 IV days 1,8. Chemotherapy was recycled on day 22 and continued for a maximum of six cycles in responding patients. Of 33 patients with measurable disease 8 (24%) achieved a complete remission (CR). The median survival for patients achieving a CR was 13 months (range 5-29 +) whilst the median survival for all 43 patients was 7 months (range 1-29 +). Only three patients are still alive-two are disease free. More effective and/or less toxic chemotherapy regimens are needed for the treatment of patients with metastatic TCC. Patients with metastatic transitional cell carcinoma (TCC) have a median survival of 3 months if untreated (Babaian et al., 1980). During the 1970's a number of cytotoxic agents were investigated for their efficacy in treating patients with advanced TCC. When used as single agents overall response rates of between 16 and 35% were consistently reported for cisplatin, methotrexate, cyclophosphamide, doxorubicin, 5-fluorouracil, and vinblastine (Yagoda et al., 1980). However complete responses were rare and response durations brief. In 1981 investigators from the Northern California Oncology Group (NCOG) began a phase II study in patients with metastatic transitional cell carcinoma of a chemotherapy combination comprising cisplatin, methotrexate and vinblas-tine (CMV). They reported on the first 60 patients entered into this study in 1985 (Harker et al., 1985) and documented a complete response rate of 28% with an overall median survival of 8 months. In 1983 the Memorial Hospital in New York began treating patients with advanced TCC with M-VAC combination chemotherapy which incorporated four of the most active single agents-methotrexate, vinblastine, doxorubicin and cisplatin. They reported their initial series in 1985 (Sternberg et al., 1985) and have since added to and updated their experience (Sternberg et al., 1988; Sternberg et al., 1989). They have consistently reported encouraging clinical complete response rates of between 26% and 48% and in their most recent report the median survival for the whole group was 13 months with an estimated probability of 4-year survival of 18% +/-7% (Sternberg et al., 1989). Both the NCOG and the Memorial groups incorporated surgical resection of residual disease, where feasible, into their treatment regimens. …