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For over 15 years, the MVAC regimen (methotrexate/vinblastine/doxorubicin/cisplatin) has been standard chemotherapy for patients with unresectable or metastatic bladder cancer. The taxanes and gemcitabine have provided new treatment options, but development of more effective regimens is needed. Gallium nitrate has significant activity as a single agent in the treatment of advanced bladder cancer, including activity in heavily pretreated patients and patients previously treated with MVAC or single-agent cisplatin. At a dosage of 300 mg/m(2) daily by continuous infusion for 5 to 7 days every 3 weeks, toxicity has been acceptable in the treatment of patients with refractory disease. Gallium nitrate is also active in combination regimens for advanced bladder cancer. Because it has a different mechanism of action, minimal myelosuppression, and activity in previously treated patients, gallium nitrate may be useful as a single agent in patients with advanced bladder cancer who fail front-line chemotherapy regimens. Evaluation of gallium nitrate in combination with newer agents such as the taxanes or gemcitabine may also be warranted given its activity, different mechanism of action, and non-overlapping toxicity profile., (Copyright 2003 Elsevier Inc. All rights reserved.)

The discovery that etoposide is one of the most active drugs in small-cell lung cancer (SCLC) led to its incorporation into a number of first-line combination chemotherapy regimens. The cyclophosphamide/doxorubicin/etoposide (CAE) regimen was shown to be as active or more active than other standard regimens in nonrandomized studies. In a randomized study presented in this report, the CAE regimen was significantly superior to the cyclophosphamide/doxorubicin/vincristine (CAV) regimen for response duration and survival in extensive-stage patients. In limited-stage patients the results were slightly better with CAE. In addition, CAE lacked the neurotoxicity of CAV.

Hormonal therapy is very effective in the treatment of patients with metastatic breast cancer. Response to various therapies leads to improved quality of life and prolonged survival. This clinical trial compared two commonly utilized additive hormonal agents, tamoxifen citrate and megestrol acetate (Megace). Preliminary data indicate equal efficacy and equal toxicity of these two hormones and suggests that both are suitable for first-line hormonal treatment of stage IV breast cancer.