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From June 1986 to December 1994 29 patients (pts) with metastatic bladder carcinoma were treated with CMV regimen as originally reported by Harker et al. , J Clin Oncol 1985. Eight out of 29 pts were treated with CBDCA instead of CDDP with dose ranging from 200 to 300 mg/m 2 because of a pre-existing nephropaty, primary or due to the neoplasm (e.g. from pelvic masses). We retrospectively evaluated responses rate, CR duration and survival from the beginning of treatment. Patient's characteristics in CDDP group were: median age 66 yr (48–79), PS ECOG 0–1, median follow-up 69 mos (6–107); in CBDCA group: median age 65yr (60–71), PS ECOG 0–1, median follow-up 38 mos (26–51). In CDDP group 10 pts (48%) achieved an objective response, with 6 CR (29%) and 4 PR (19%), while in CBDCA group 3 pts (37%) showed an objective response with 2 CR and 1 PR. The median duration of CR was 30.5 mos in CDDP pts and 19 mos in CBDCA group, while the median survivals from the beginning of CT were 12 and 10.5 mos respectively. Two pts who received CDDP are still alive and free front relapse at 67 and 69 months. Toxicities ≥3 WHO in CDDP group: neutropenia in 3, piastrinopenia in 2, anemia in 2 and gastroenteric toxicity in 4; in CBDCA group: neutropenia in 3, anemia in 1 and gastroenteric toxicity in 1; no piastrinopania G3–G4 was observed Conclusions Our results confirm the previous reports and the efficacy of CMV regimen in metastatic bladder cancer, the regimens containing CBDCA are slightly less effective.

A total of 44 patients with infiltrating, locally advanced bladder cancer (stages T 3a-b, T 4a-b and N+/N0) were treated with the systemic chemotherapy regimen of cisplatin, methotrexate and vinblastine (CMV) in the neoadjuvant setting, of whom 39 were evaluable for response. After planned radical cystectomy and 2 to 3 cycles of chemotherapy no tumor was found on the pathological specimen of 4 patients (10%), the tumor was downstaged in 19 (49%) and no change was observed in 16 (41%).Toxicity included leukopenia in 29 patients (66%), 1 of whom died of granulocytopenic sepsis, nausea and vomiting in 39 (89%) and mild to moderate mucositis in 18 (41%). Median followup is 12 months with a range of 6 to 39 months. Of 32 patients followed for longer than 6 months 6 (19%) experienced progression or recurrence of disease. We conclude that preoperative CMV chemotherapy is effective in inducing downstaging of the tumor, although systemic toxicity limits its use to cautiously selected patients.

One-hundred and twenty-one cases of malignant pleural mesothelioma (MPM) seen between 1986 and 1999 at the authors' Institution were reviewed. Histotype was epithelial in 88 patients (73%), sarcomatous in 21 (17%) and mixed in 12 (10%). Ninety-one patients received a treatment (38 palliative pleurectomy and no further therapy, 16 palliative pleurectomy followed by chemotherapy, 37 chemotherapy alone), while 30 were referred to supportive care only. Median survival of the whole population was 10.5 months. The 1-, 2- and 3-year survival were 40, 17 and 8%, respectively. Univariate analysis of subgroups showed that poor performance status (PS), non-epithelial histotype, Butchart stage>I and International Mesothelioma Interest Group (IMIG) stage>I were individually associated with lower survival. Patients receiving any therapy survived longer than patients treated with supportive care only (P=0.0004). Treatment modality had an independent prognostic value (P=0.00005), with a survival advantage for patients receiving surgery and adjuvant chemotherapy. Multivariate analysis confirmed the independent prognostic value of PS (P=0.001; HR=2.48) and treatment modality (P=0.003; HR=1.38). The prognostic role of PS (P=0.02) and treatment modality (P=0.01) was confirmed in the subset of patients with epithelial histology. On the contrary, therapy had no impact on survival in patients with sarcomatoid MPM (P=0.74). Despite the predicted bias of a retrospective non-randomized evaluation of treatment-related factors, patients with good PS and epithelial histology seemed to have a survival benefit from surgery or multimodality therapy, as opposite to patients with poor PS or non-epithelial histotype. However, these results must be confirmed in a larger prospective trial with uniform treatment.

(1999). Meningeal Carcinomatosis from Transitional Cell Carcinoma of the Bladder: Report of Two Cases and Review of the Literature. Cancer Investigation: Vol. 17, No. 6, pp. 402-407.