Methotrexate Treatment for Advanced Bladder Cancer

Hall, R. R.; Bloom, H. J. G.; Freeman, J. E.; Nawrocki, Artur; Wallace, D. M. A.

doi:10.1111/j.1464-410x.1974.tb10181.x

Cited by 41 publications

(10 citation statements)

References 15 publications

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“…The latter may have the additional merit of being effective against micrometastases outside the irradiated volume. Carter & Wasserman (1975) found significant cytotoxic activity against bladder cancer with only three agents, namely adriamycin, 5-fluouracil and mitomycin-C. We have reported on the effect of methotrexate in advanced cases (Hall et al 1974, Turner et al 1977: the overall objective response rate in 61 patients treated with this agent was 38%, with remissions lasting two to six months (average 8.7 months). Intravenous doses of 50, 100 or 200 mg were given every two weeks, the greatest dose level being associated with a citrovorum rescue procedure.…”

Section: Prognosis Influenced By Agementioning

confidence: 91%

Treatment of Infiltrating Bladder Cancer

Bloom

1979

J R Soc Med

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In the field of urological oncology there can be no greater therapeutic challenge for the urologist and radiotherapist than a bladder tumour which is found to be infiltrating muscle. The threat to life by such lesions is of varying magnitude, depending upon the precise depth of mural infiltration. In patients with tumour limited to the superficial muscle (stage T2), cure is anticipated, whereas in those cases showing involvement of deep muscle or perivesical fat (stage T3a and T3b), therapeutic failure leading to death within two years is not unexpected.Bladder tumours with muscle involvement are not early enough to be dismissed after one or more sessions of transurethral cystodiathermy, nor so late as to be relegated to palliative procedures. A radical approach is required, although in some cases not necessarily amounting to total cystectomy nor to large volume external beam therapy.T2 tumours Before the megavoltage era, interstitial irradiation was an attractive method of treatment, enabling high doses to be delivered locally in a deep-seated organ without heavily irradiating the normal surrounding tissues. With the advent of megavoltage equipment and with more aggressive methods of endoscopic resection, the indications for interstitial treatment for bladder cancer have diminished. Thus, at the Christie Hospital, Manchester, the proportion of cases treated by radioactive implant has fallen from 41% in 1953in , to 3% in 1969in (Pointon 1973.Interstitial irradiation in the bladder now appears to be used at only a few centres, mainly in Europe. The techniques and materials for this type of treatment have been reviewed elsewhere (Bloom & Wallace 1971).The ideal case for interstitial therapy is one with a solitary tumour of relatively low-grade malignancy whose base does not exceed 4-5 cm in diameter, with early muscle infiltration and with no obvious malignant or premalignant changes in the bladder away from the tumour site. This technique has also been employed for patients with mucosal tumours (T1) which are large, sessile and solid-looking, and especially when biopsy shows poor differentiation and there is doubt regarding the precise depth of infiltration.The principal advantages associated with interstitial irradiation are that a substantial cure rate is obtained with a low operative morbidity and mortality (2-4%); that irradiation is restricted to a portion of the bladder wall, with sparing of the extravesical tissues; and that if cure is not achieved, other methods of treatment are not precluded.

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Section: Prognosis Influenced By Agementioning

confidence: 91%

Treatment of Infiltrating Bladder Cancer

Bloom

1979

J R Soc Med

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“…Of note. greater than 50% of the patients had severe toxicity: 27 (T· hi, ~) ind1catt IV q week. Thus, available data ,t t: -fJ methotrexate is efficacious in the treatment and transitional cell carcinoma of the urothclial tract further Phase II studies are warranted.…”

Section: Methotrexatementioning

confidence: 97%

“…24 hours thereafter. greater than 50% of the patients had severe toxicity: 27 . 27 • 53 Of 11 responders, five had only T 1 _ 3 or T4 lesions, one had a palpable pelvic node, and one had a T4 lesion and osseous metastases.…”

Section: Methotrexatementioning

confidence: 99%

Chemotherapy of Metastatic Bladder Cancer

Yagoda

1980

Cancer

104

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Recent disease-oriented phase II clinical trials in advanced transitional cell carcinoma of the urothelial tract have defined the therapeutic efficacy of cis-diamminedichloride platinum II, Adriamycin and methotrexate. Other agents which may have some activity include cyclophosphamide, the podophyllotoxins, hexamethylmelamine, and possibly 5-flourouracil. While combination drug regimens have been reported to induce higher remission rates when compared to single agents, prospective randomized trials will be needed to document enhanced therapeutic benefit. The problems in selecting appropriate patients and in defining response criteria in clinical trials in urothelial tumors are discussed. Chemotherapy data in the treatment of bladder cancer is summarized, using strict response criteria.

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“…Methotrexate is an anti-folate agent that has been shown to be active in parenteral form against transitional cell carcinoma of the bladder, both as a sole agent (Hall et al, 1974) and in combination with cisplatinum (Turner et al, 1977) in invasive cancer. Following reports of decreased recurrence rates (Hall et al, 1981) there was also sufficient interest in methotrexate as an oral agent for the Medical Research Council (MRC) to try to set up a national trial investigating its use in superficial bladder tumours, but this was abandoned because of lack of recruitment.…”

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confidence: 99%

Intravesical Methotrexate in the Treatment of Superficial Bladder Cancer

Smith

Theodorou

Field

et al. 1984

British Journal of Urology

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Thirty patients with superficial bladder cancer (Tis, Ta, Tl) difficult to control by endoscopic means were given a total of 49 courses of methotrexate at fortnightly intervals. Four concentrations were investigated. In 14 courses this was the sole treatment and in the remainder the methotrexate was given as prophylaxis. Toxicity was not a problem but in both groups, although there was some evidence of anti-tumour activity, there were high recurrence rates and intravesical methotrexate cannot be recommended.

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Methotrexate Treatment for Advanced Bladder Cancer

Cited by 41 publications

References 15 publications

Treatment of Infiltrating Bladder Cancer

Treatment of Infiltrating Bladder Cancer

Chemotherapy of Metastatic Bladder Cancer

Intravesical Methotrexate in the Treatment of Superficial Bladder Cancer

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