Combination chemotherapy with ifosfamide, 5-fuluorouracil, etoposide and cisplatin for advanced urothelial cancer: the treatment results and significance of tumor marker evaluation in response assessment of chemotherapy

Abstract

We investigated treatment results of IFEPchemotherapy in patients with advanced urothelial cancer (N2-3, M1) and the usefulness of measuring serum CEA, CA19-9 and SCC to evaluate the treatment response of chemotherapy. From March 1994 to May 2000, we treated 41 patients with IFEP therapy consisting of ifosfamide (2 g/m2), 5-fluorouracil (750 mg/m2), etoposide (100 mg/m2) and cisplatin (20 mg/m2), all of which were given daily for 3 consecutive days every 3 weeks. Before initiating the chemotherapy, serum CEA, CA19-9 and SCC were measured. And in patients with high pretreatment serum concentration, they were serially evaluated and compared with the tumor response assessed by imaging studies and the patients' clinical course. The response rate of the chemotherapy was 53.7% (CR + PR), with a median survival period being 10.8 months and a median duration of response for the 22 responders being 7.5 months. One and three-year survival rates of all the patients were 59.3% and 16.5%. Response rates of primary tumors and metastatic lesions to the lymph node, bone, lung and liver were in 54% and 57%, 56%, 50% and 40%, respectively. Bone marrow toxicity was significant with 1 drug-related death. Before chemotherapy, tumor marker was elevated in 19 patients: CEA in 7, CA19-9 in 13 and SCC in 10. Serum levels of the tumor markers were related neither to the primary and metastatic tumor sites nor to patient's survival time. However, decline of serum tumor markers after chemotherapy was well related to response of the tumor assessed by imaging studies. IFEP chemotherapy appears to be active in the treatment of advanced urothelial tumor and serial measurement of serum CEA, CA19-9 and SCC may be useful in judgement of tumor response to the chemotherapy.