Combination Chemotherapy in Treating Patients With Bladder Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed transitional cell carcinoma of the bladder

• Any T, N+, M0 OR

• T3a-4a, N0, M0

• At least 6 weeks but no more than 3 months since prior complete resection of bladder

• Cystoprostatectomy plus pelvic lymph node dissection in males

• Cystectomy/total abdominal hysterectomy/bilateral salpingo-oophorectomy plus pelvic lymph node dissection in females

• Negative surgical margins

• Carcinoma in situ allowed

• No partial cystectomy or transurethral bladder tumor resection as definitive loco-regional therapy

• Prostate cancer detected in resected specimen allowed if post-operative PSA is no more than 0.05 mg/dL

• No metastatic or recurrent disease by post-operative chest x-ray and CT scan of abdomen and pelvis

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• ECOG 0-1

Hematopoietic:

• Absolute neutrophil count ≥ 1,500/mm^3

• Platelet count ≥ 150,000/mm^3

Hepatic:

• Bilirubin ≤ 1.5 times upper limit of normal (ULN)

• Alkaline phosphatase ≤ 2 times ULN

• AST ≤ 2 times ULN

Renal:

• Creatinine ≤ 1.5 mg/dL OR

• Creatinine clearance ≥ 60 mL/min

Cardiovascular:

• Normal cardiac function by history, physical exam, or chest radiograph

• Left ventricular ejection fraction at least 50% by radionuclide ventriculogram or echocardiogram, for prior cardiac disease

• No New York Heart Association class III or IV heart disease

• No serious cardiac arrhythmias including first-, second-, and third-degree heart block

Other:

• Negative pregnancy test

• No uncontrolled infection

• No other active cancer within the past 5 years except non-melanoma skin cancer or curatively treated carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• No prior systemic chemotherapy

Endocrine therapy:

• Not specified

Radiotherapy:

• No prior radiotherapy to bladder