Einhorn Lawrence
Department of Medicine, Indiana University, Indianapolis, IN 46202, USA.
Semin Oncol. 2003 Apr;30(2 Suppl 5):34-41. doi: 10.1016/s0093-7754(03)00174-x.
For over 15 years, the MVAC regimen (methotrexate/vinblastine/doxorubicin/cisplatin) has been standard chemotherapy for patients with unresectable or metastatic bladder cancer. The taxanes and gemcitabine have provided new treatment options, but development of more effective regimens is needed. Gallium nitrate has significant activity as a single agent in the treatment of advanced bladder cancer, including activity in heavily pretreated patients and patients previously treated with MVAC or single-agent cisplatin. At a dosage of 300 mg/m(2) daily by continuous infusion for 5 to 7 days every 3 weeks, toxicity has been acceptable in the treatment of patients with refractory disease. Gallium nitrate is also active in combination regimens for advanced bladder cancer. Because it has a different mechanism of action, minimal myelosuppression, and activity in previously treated patients, gallium nitrate may be useful as a single agent in patients with advanced bladder cancer who fail front-line chemotherapy regimens. Evaluation of gallium nitrate in combination with newer agents such as the taxanes or gemcitabine may also be warranted given its activity, different mechanism of action, and non-overlapping toxicity profile.
15 年多来，MVAC 方案（甲氨蝶呤/长春花碱/阿霉素/顺铂）一直是不可切除或转移性膀胱癌患者的标准化疗方案。紫杉烷类和吉西他滨提供了新的治疗选择，但仍需要开发更有效的方案。硝酸镓作为单一药物在晚期膀胱癌治疗中具有显著活性，包括在接受过大量预处理的患者以及先前接受过 MVAC 或单一药物顺铂治疗的患者中也有活性。以每 3 周连续输注 5 至 7 天、每日剂量 300 mg/m² 的方式给药，在治疗难治性疾病患者时毒性是可接受的。硝酸镓在晚期膀胱癌的联合方案中也有活性。由于其作用机制不同、骨髓抑制作用极小且在先前接受过治疗的患者中有活性，硝酸镓可能对一线化疗方案失败的晚期膀胱癌患者作为单一药物有用。鉴于其活性、不同的作用机制和不重叠的毒性特征，对硝酸镓与紫杉烷类或吉西他滨等新型药物联合使用进行评估也可能是必要的。
