Gemcitabin in der Behand- lung des fortgeschrittenen Urothelkarzinoms

Abstract MVAC (methotrexate,vinblastine,doxorubicin,cisplatin) has been the standard treatment forpatients with advanced urothelial cancer formore than 15 years.Combination chemotherapyincluding gemcitabine/cisplatin showed similartumor response and survival rates with a moretolerable toxicity profile in a recent multinationalphase III study when compared to MVAC.Effec-tivity of gemcitabine as a single agent or in com-bination with other cytotoxic agents had beeninvestigated before in several phase II studiestreating patients with advanced urothelial can-cers.The tumor response rate for single agentgemcitabine in advanced urothelial cancers isbetween 11% and 28%.Tumor response ratesrise to 50% when combining gemcitabine withcisplatin,and median survival times between 12and 15 months can be expected.Triplet therapyschedules including gemcitabine may yield re-sponse rates in up to 80% of patients,particularlywhen used sequentially with other regimens.Further improvement of tolerability during sys-temic gemcitabine/cisplatin combination thera-py without compromising effectivity was recent-ly demonstrated by a German phase II studywhen the 4-week schedule was reduced to a 3-week schedule with gemcitabine given ondays 1 and 8.