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.