UC responds very well to cisplatin-based chemotherapy, represented by gemcitabine-cisplatin (GC) therapy; therefore, this treatment is widely administered to patients with UC. However, effective chemotherapy regimens, other than cisplatin-based chemotherapies, for patients with UC have not been established, although many clinical trials are ongoing. Oxaliplatin is more effective than cisplatin
in vitro, and has shown efficacy in preclinical studies using many tumor cell lines [
1]. In addition, Siew
et al. demonstrated the efficacy of oxaliplatin, an immunogenic cell death inducer, on the induction of stress ligands and promotion of natural killer cell-mediated cytotoxicity in human ovarian cancer [
2]. The efficacy of an oxaliplatin alone chemotherapy for advanced or metastatic UC was minimal in phase II studies. Those studies showed response rates of not more than several percent [
3,
4]. The efficacy of 5-fluorouracil (5-FU) for advanced UC remains unclear, but a review of published studies in 1987 described response rates of approximately 15% using the unmodulated single agent 5-FU [
5]. In addition, a phase II trial of continuous 5-FU infusion in 2009 showed a median progression-free survival of 1.9 months, a median overall survival of 6.5 months, and a response rate of 20% [
6].
In 2008, a phase II study was performed to determine the efficacy of irinotecan monotherapy for advanced transitional cell carcinoma of the urothelium; the median progression-free survival was 2.1 months and the median overall survival was 5.4 months [
7]. However, these monotherapy regimens do not usually give good responses for cancers, including colorectal cancer. The response rates of irinotecan, oxaliplatin, and 5-FU were only approximately 18%, 20%, and 21%, respectively. On the other hand, combination therapies using a combination of fluorouracil, leucovorin, and irinotecan (FOLFIRI), a combination of fluorouracil, leucovorin, and oxaliplatin (FOLFOX), and FOLFOXIRI had stronger activities in colorectal carcinoma [
8‐
11]. There are some reports on the use of combination therapies for patients with UC. The case report about the use of FOLFIRI for UC by Lu
et al. showed that UTUC was well controlled by the chemotherapy regimen, and, that it was effective for metastatic colorectal cancer [
12]. There are few reports of FOLFOX therapy for UC, with only a phase II trial by Lorenzo
et al. [
13]. They used FOLFOX in 18 patients who had previously been treated for UC, and reported only low-grade toxicity and a 19% overall response rate [
13]. The case report of FOLFOX for UC by Seo
et al. showed a complete response in a patient who developed lung metastasis and an additional primary colon cancer after radical nephrectomy for the UC [
14]. In our patient with UC, chemotherapy with FOLFOXIRI resulted in an extremely good response.