Mdash;VAC remains the standard of care for metastatic transitional cell carcinoma (TCC), but its limitations include significant toxicity and infrequent durable diseasedash;free survival. Recent investigation has focused on the identification of novel chemotherapeutics with singledash;agent activity in metastatic TCC and on their incorporation into more active combination regimens. Paclitaxel, gemcitabine and ifosfamide are among the most active new agents. Numerous phase II trials of novel combinations have yielded promising preliminary results. Longer followdash;up and results from randomized trials will be necessary to determine the impact of newer chemotherapy regimens on survival. Curr Opin Urol 8:413ndash;418. copy; 1998 Lippincott Williams amp; Wilkins.
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