Phase III Trial of Methotrexate, Vinblastine, Doxorubicin and Cisplatin vs Carboplatin and Paclitaxel in Advanced Carcinoma of the Urothelium

Inclusion Criteria

DISEASE CHARACTERISTICS: Histologically confirmed transitional cell carcinoma of the
urothelium (renal pelvis, ureter, bladder, or urethra) or mixed histologies containing a
component of transitional cell carcinoma of the urothelium with manifestations of
progressing regional or metastatic cancer Clinically unsuspected organ-confined prostate
cancer found during cystoprostatectomy allowed Evaluable or measurable disease No
significant pericardial or pleural effusion or edema No significant ascites No CNS
metastases

PATIENT CHARACTERISTICS: Age: 18 and over Performance status: ECOG 0-2 Life expectancy:
Not specified Hematopoietic: Granulocyte count at least 1,500/mm3 Platelet count at least
100,000/mm3 Hepatic: AST no greater than 2 times upper limit of normal Bilirubin no
greater than 1.5 mg/dL Renal: Creatinine no greater than 1.7 mg/dL Cardiovascular: No
history of severe cardiovascular disease (American Heart Association class III or IV),
uncontrolled congestive heart failure, or cardiac dysrhythmias Other: Prior malignancy
allowed if curatively treated with no evidence of recurrence No active infection requiring
parenteral antibiotics Not pregnant or nursing Fertile patients must use effective
contraception

PRIOR CONCURRENT THERAPY: Biologic therapy: No prior systemic biologic response modifier
therapy No concurrent filgrastim (G-CSF) within 24 hours prior to and after study
chemotherapy administration Chemotherapy: No prior systemic chemotherapy Endocrine
therapy: Not specified Radiotherapy: No prior pelvic radiotherapy as a component of
bladder-sparing therapy or as an adjuvant for locally advanced disease with positive
margins No concurrent local radiotherapy for pain control or life-threatening situations
Surgery: See Disease Characteristics