Gemcitabine, Paclitaxel, Doxorubicin in Metastatic or Unresectable Bladder Cancer With Decreased Kidney Function

Inclusion Criteria:

Histologically or cytologically confirmed transitional cell carcinoma (TCC) of the bladder, urethra, or upper urinary tract
Mixed TCC and variant histologies (i.e., small cell, squamous cell, adenocarcinoma, or sarcoma) allowed if present in < 50% of the biopsy specimen
Patients must sign an informed consent indicating that they are aware of the investigational nature of this study, in keeping with the policies of the institution.
Measurable disease: may include radiographic detection of metastases in lymph nodes (>= 1.5 cm) or liver or lung (>= 1.0 cm) OR pelvic mass palpable on examination under anesthesia
Creatinine clearance < 60 mL/min; no renal insufficiency that requires hemodialysis; no renal insufficiency that is reversible in patients with tumor confined to the primary site (i.e., that is potentially resectable with neoadjuvant chemotherapy)
Zubrod performance status 0-2
Platelet count > 100,000/mm^3
Absolute granulocyte count > 1,500/mm^3
Bilirubin =< 2.0 mg/dL
Aminotransferases (AST and ALT) =< 2 times upper limit of normal
Left ventricular ejection fraction (LVEF) > 40% OR normal electrocardiogram (EKG or ECG) and no history of cardiac disease
All patients must be evaluated in the Department of Genitourinary Medical Oncology at M. D. Anderson Cancer Center or participating CCOP center prior to signing informed consent.
No prior systemic chemotherapy including, adjuvant or neoadjuvant therapy
Prior intravesicular chemotherapy allowed

Exclusion Criteria:

No brain metastases
Not pregnant or nursing
No severe or uncontrolled infection
No New York Heart Association class III-IV congestive heart failure, unstable angina, or history of myocardial infarction within the past 6 months
No peripheral neuropathy >= grade 2
No persistently uncontrolled diabetes mellitus
No chronic liver disease
No HIV positivity
No other malignancy except nonmelanoma skin cancer unless disease-free for the past 3 years
No overt psychosis, mental disability, or other condition that would preclude giving informed consent
No known sickle cell disease
No uncontrolled severe hypertension
Renal insufficiency that requires hemodialysis or renal insufficiency that is reversible in patients with tumor confined to the primary site (i.e., that is potentially resectable with neoadjuvant chemotherapy).