Non–Cisplatin-Containing Chemotherapy in Patients with Advanced Urothelial Cancer

Cisplatin — the most active agent for patients with advanced urothelial cancer — often is combined with other agents in this difficult-to-treat population. Although M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) historically has been the preferred treatment regimen, the combination of gemcitabine plus cisplatin has become more popular recently, given its similar activity and better toxicity profile. Despite these advances, many patients with urothelial cancer suffer from age- or disease-related declines in renal function and performance status that render them unable to tolerate cisplatin-based therapy. Although alternative options, such as carboplatin and gemcitabine, are less nephrotoxic than cisplatin, current evidence sug…