Vinblastine and Methotrexate for Advanced Bladder Cancer

Abstract

Patients (57) with advanced measurable urothelial tract cancer, 52 of whom had an adequate trial, were treated weekly with 3-4 mg per m2 vinblastine and 30-40 mg per m2 methotrexate. Of 3 patients with unidimensional parameters 2 showed improvement lasting 16 and 27 mo., which was documented by serial cystoscopic examinations. An additional 2 patients had measurable disease that could have been encompassed in a preoperative radiotherapy field. Both patients are free of disease at > 12 and 14 mo., respectively. Of the 47 patients with bidimensionally measurable parameters 19 (40%) achieved a complete or partial remission lasting a median of 8 mo., with a range of 1-24 mo. Of 25 patients with intra-abdominal or pelvic disease 7 achieved a complete or partial remission and 5 also had a minor remission. Of note, 18 of 38 patients who had received no prior chemotherapy achieved a remission vs. 1 of 9 who had been treated previously(P = 0.06). Responders frequently obtained another remission with subsequent chemotherapy (4 of 9 vs. 0 of 16, P = 0.03). Responders lived 14 mo. vs. 8 mo. for nonresponders (P = 0.02). Four responders had brain metastases compared to none of 28 nonresponders. The combination of vinblastine and methotrexate is a well tolerated, effective outpatient regimen for patients with urothelial tract cancers.