Methotrexate: An active drug in bladder cancer

Abstract

Forty-nine patients with transitional urothelial tract tumors received methotrexate: 0.5–1.0 mg/kg I.V. Q W (40 patients) or 250 mg/M² in a 2-hour infusion with citrovorum factor rescue 24 hours later (nine patients). Eleven (26%, 95% confidence limits 13–39%) of 42 patients with bidimensionally measurable metastases achieved partial remission. Most responses occurred within 2–3 weeks and persisted for a median duration of six months (range, 2–20). Response rates were increased to 38% (6/16 patients, 95% confidence limits 18–65%) in patients who had no prior chemotherapy, and a 90–100% performance status (50,5/10 patients, 95% confidence limits 22–78%) compared with 19% (5/26, 95% confidence limits 8–37%) in patients who had prior chemotherapy and a ≦80% performance status (19%, 6/32 cases, 95% confidence limits 9–32%). Toxicity included mucositis and myelosuppression. A review of the literature coupled with the present data suggest that methotrexate is as active as cisplatin in the treatment of patients with advanced urinary bladder cancer.