Combination chemotherapy with cyclophosphamide, doxorubicin, and bleomycin for metastatic transitional cell carcinoma of the urinary tract.

Twenty-three patients with metastatic transitional cell carcinoma of the urinary tract received at least two courses of the combination of cyclophosphamide, doxorubicin, and bleomycin. Eight patients (35%) achieved partial remission and an additional six (26%) had stable disease. Duration of survival was significantly longer for the partial responders (median, 30 weeks) than the remaining patients (median, 18 weeks). Principal morbidity (mucositis, fever, and pulmonary toxicity) was due to bleomycin. These results are not superior to single-agent chemotherapy and reinforce the need for further careful evaluation of new combination programs containing cis-diamminedichloroplatinum(II). The failure of bleomycin to improve responses and its considerable toxicity suggest that its continued systemic use in this disease is not warranted.