Docetaxel in the management of advanced or metastatic urothelial tract cancer.

Phase II studies of single-agent docetaxel (Taxotere) yielded promising results in advanced or metastatic transitional cell carcinoma (TCC) of the urothelium. Antitumor responses have been demonstrated in previously treated and chemotherapy-naive TCC patients, as well as in a subgroup of patients with renal impairment unable to receive traditional cisplatin-based regimens. Investigations of docetaxel-containing doublet and triplet drug combinations in the first-line setting have been pursued. When combined with cisplatin in previously untreated patients, response rates of 52% to 60% have been achieved, with median overall survival of 8 to 13.6 months. Triplet drug combinations of the docetaxel/platinum base have been investigated, when the addition of an anthracycline (doxorubicin or epirubicin [Ellence]) or of gemcitabine (Gemzar) has proven feasible, and has resulted in favorable efficacy findings. Non-platinum-containing regimens such as docetaxel/gemcitabine are also being studied. Randomizedphase III trials of a docetaxel-containing regimen in comparison with established regimens are ongoing, and additional studies are warranted to determine if overall long-term survival of TCCpatients can be improved.