Complete response of urothelial carcinoma to chemotherapy in renal allograft recipients: a two-case study.

BACKGROUND

The risk of urothelial carcinoma (UC) is increased in patients with end-stage renal disease. Standard regimens for UC (e.g., M-VAC) carry substantial toxicity, which could be exacerbated in patients with end-stage renal disease receiving kidney transplantation, because of the need to take immunosuppressants for life.

PATIENTS AND

METHODS

Patients who had metastatic UC, and normal bone marrow, liver and kidney functions, were eligible. The TP-HDFL regimen included: paclitaxel 70 mg/m2 1-hour intravenously (i.v.) on days 1, 8; cisplatin 35 mg/m2 24-hour (i.v.) on days 2 and 9; and 5-fluorouracil 2, 000 mg/m2 and leucovorin 300 mg/m2 24-hour (i.v.) on days 2 and 9; repeated every 21 days. Concomitant immunosuppressants were maintained during chemotherapy.

RESULTS

From 2003 to 2004, two female renal allograft recipients developed renal pelvis UC with para-aortic and lung metastasis, respectively. They received four to six cycles of the TP-HDFL regimen and achieved complete response. There was neither significant toxicity, nor immunosuppressant dose-adjustment. The patients remained disease-free for 2 and 1 year, respectively, after completion of the chemotherapy.

CONCLUSION

The TP-HDFL regimen showed activity and can be safely used in renal allograft recipients with metastatic UC.