New chemotherapy regimens for advanced bladder cancer.

Because of demonstrated superiority in multiple randomized trials, MVAC has become the standard therapy for metastatic or unresectable bladder cancer. However, the disappointing long-term results with this regimen have prompted the development of newer agents and regimens for this disease. These include novel antifolates, gemcitabine, taxanes, ifosfamide, and gallium nitrate. Each of these agents leads to objective responses, including complete responses in both untreated and previously treated patients. More recent reports of combination regimens using these agents suggest that response rates are equivalent to those seen with MVAC but that there is significantly less toxicity. These observations, if confirmed in randomized trials, would signify an important advance in the therapy of metastatic bladder cancer.