Pemetrexed Disodium and Gemcitabine in Treating Patients With Advanced Cancer of the Urothelium

DISEASE CHARACTERISTICS:

Histologically confirmed cancer of the urothelium (renal pelvis, ureter, bladder, or urethra)

Any of the following types:

Transitional cell carcinoma (TCC)
Mixed histologies containing a component of TCC
Non-TCC of the urothelium (renal pelvis, ureter, bladder, or urethra)
Progressing regional or metastatic disease
Measurable disease
No clinical evidence of CNS metastases
No evidence of clinically significant (by physical exam or plain film) third-space fluid collections (pleural effusions or ascites)

PATIENT CHARACTERISTICS:

Age

18 and over

Performance status

ECOG 0-2

Life expectancy

Not specified

Hematopoietic

Granulocyte count at least 1,500/mm^3
Platelet count at least 100,000/mm^3
Hemoglobin at least 9 g/dL

Hepatic

AST no greater than 3 times upper limit of normal (ULN)
Bilirubin no greater than 1.5 times ULN

Renal

Creatinine clearance at least 45 mL/min

Cardiovascular

No history of severe cardiovascular disease (i.e., American Heart Association class III or IV heart disease)
No uncontrolled congestive heart failure
No ventricular dysrhythmias

Other

Not pregnant or nursing
Fertile patients must use effective contraception
No active unresolved infection
No other prior malignancy unless curatively treated and disease free for an appropriate (disease-specific) period of time
Able and willing to receive folic acid and cyanocobalamin supplementation

PRIOR CONCURRENT THERAPY:

Biologic therapy

No prior systemic biologic response modifier therapy

Chemotherapy

No prior systemic chemotherapy for metastatic disease
More than 1 year since prior neoadjuvant or adjuvant chemotherapy

Endocrine therapy

Not specified

Radiotherapy

At least 4 weeks since prior radiotherapy and recovered
No prior pelvic radiotherapy
No concurrent radiotherapy

Surgery

At least 4 weeks since prior major surgery and recovered

Other

More than 7 days since prior parenteral antibiotics
No salicylates for 2 days before, during, and for 2 days after administration of pemetrexed disodium
No nonsteroidal anti-inflammatory drugs for at least 5 days before, during, and for 2 days after administration of pemetrexed disodium