Gemcitabina: Una nuova possibilita terapeutica nei tumori avanzati dell'urotelio

Advanced urothelial cancer is considered a chemo-responsive disease. However, in spite of this, it is still considered a poor prognosis disease as the median survival of patients treated with MVAC drug-combination (methotrexate, vinblastine, doxorubicin and cisplatin) - considered the 'gold standard' in this kind of treatment - does not exceed 12 months. Moreover, the initial response rate of 72% reported by Sternberg et al. at Memorial Sloan Kettering Cancer Center, was never reported by other Authors who observed response rates around 40%. In addition, this treatment is often accompanied by severe toxicity which may sometimes overwhelm the benefit. A novel antitumor agent, gemcitabine, has been found in phase I studies, to be well tolerated and active in patients who had progressed on MVAC. Three phase II studies on bladder cancer have confirmed the high activity and low toxicity of gemcitabine reporting response rates ranging from 22.5% in pretreated patients to 30% in patients not previously submitted to cisplatin. Moreover, the combination of gemcitabine plus cisplatin in two phase II studies, obtained 41% to 75% response with moderate toxicity. A phase III ongoing study is comparing MVAC to gemcitabine-cisplatin in order to precisely define the role of this new drug in the treatment of bladder cancer.