Phase II Trial of 5-FU, Leucovorin, Gemcitabine, and Cisplatin for Adenocarcinomas of the Urothelial Tract and Urachal Remnant
1. Histologic proof of cancer originating from the urinary tract with adenocarcinoma as
the predominant (>/= 50%) histology. Dr. Czerniak and/or Dr. Tamboli will be
consulted in equivocal cases of mixed histology. The Study Chairman is the final
arbiter in questions of mixed histology.
2. Bi-dimensionally measurable disease. All patients must have measurable or evaluable
disease. In general, liver and lung lesions should be at least 1 cm, and patients
with node-only disease should have lesions of >/= 1.5 cm in greatest dimension.
Patients with disease confined to bone may be eligible if a measurable lytic defect,
or soft-tissue component in present. Those without measurable disease may be eligible
if a serum marker is elevated (>/= 4 x ULN) (ie: CEA, CA-125, CA19-9, bhCG, etc).
3. (# 2 cont'd) The Study Chairman is the final arbiter in questions related to
measurability. Patients with a three-dimensional mass or pelvic sidewall fixation on
bladder examination under anesthesia are considered to have measurable disease.
4. Patients are eligible if they have evidence of metastatic disease, or if their tumor
is surgically unresectable. In the absence of grossly metastatic disease, all
patients should be seen and evaluated by a member of the Urology staff to assess
their potential for resection.
5. Patients must have adequate physiologic reserves as evidenced by: • Life expectancy
of at least 9 months (based on co-morbidity) & at least 9 weeks based on the natural
history of their cancer. • Zubrod Performance Status (PS) of = 2; or 3 if of recent
onset and due entirely to the cancer and not to comorbidity, and especially if the
compromised performance status is due to uncontrolled pain which is expected to be
rapidly reversible when therapy starts.
6. (#5 cont'd) • Adequate bone marrow function as defined by absolute neutrophil count
>/= 1,800 and platelet count >/= 150,000. Supranormal values judged to be of benign
or inconsequential etiology are acceptable. • Transaminase (either SGPT or SGOT) =
2x the upper limit of normal. • Conjugated bilirubin = 2x the upper limit of
normal. • Creatinine clearance (either measured or estimated using the formula of
Cockcroft and Gault) of >/= 35 mL/min: CLcr = [(140-age) • wt(kg)]/[72 •Creat
(mg/dL)] (For females, x 0.85)
7. Patients must sign an informed consent indicating that they are aware of the
investigational nature of this study, in keeping with the policies of this hospital.
8. Patients must be at least 6 weeks out from pelvic irradiation, and must not have had
more than 10% of the bone marrow irradiated.
9. Patients with a history of cardiac disease, or evidence of ischemic heart disease on
EKG must have adequate cardiac function with an EF >/= 40% to participate.
10. Patient must be at least 18 years of age to participate in this study.
1. Patients with metastases to the bladder from a primary adenocarcinoma arising outside
the urinary tract are ineligible.
2. Overt psychosis or mental disability or otherwise incompetent to give informed
3. A life threatening illness (unrelated to tumor) that would prevent completion of
4. Pregnant or nursing women, as the drug therapy regimen, and support medications pose
significant potential risks to the fetus and newborn.
5. Patients with second malignancies are eligible provided that the expected outcome
from the second cancer is such that this will not interfere in the delivery of this
therapy, or the assessment of response.
6. Patients with uncontrolled CNS metastases are not eligible.