Pemetrexed Disodium in Treating Patients With Previously Treated Metastatic Urothelial Cancer

Inclusion Criteria

• •Patients must have histological confirmation of metastatic urothelial carcinoma; patients must have sufficient tumor tissues for future MTAP testing and research; histological variants such as glandular, squamous, sarcomatoid, micropapillary, plasmacytoid, and small cell changes will not be allowed for this trial unless these tumors are MTAP-deficient
• •Patients who have received any non-anti-folate containing neoadjuvant or systemic chemotherapy are eligible; any prior intravesical therapy, or immunotherapy is allowed
• •Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status =\< 2
• •Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =\< 3 x upper limit normal (ULN), or =\< 5 x ULN if documented liver metastases are present
• •Total bilirubin =\< 1.5 x ULN, except subjects with Gilbert's syndrome or liver metastases, who must have a baseline total bilirubin =\< 3.0 mg/dL
• •Absolute neutrophil count (ANC) \>= 1500
• •Platelets \>= 100,000
• •Normal serum creatinine, or a creatinine clearance \>= 40 ml/min (either measured using a 24 hour urine, calculated using Cockroft-Gault, or estimated using the Modification of Diet in Renal Disease \[MDRD\] method from the National Kidney Disease Education Program \[NKDEP\] \[the method reported by M D Anderson Cancer Center (MDACC) laboratories\])
• •Females of childbearing potential who are sexually active with a non-sterilized male partner and non-sterilized males must use a highly effective method of contraception for 28 days prior to the first dose of investigational product, and must agree to continue using such precautions for 180 days after the final dose of investigational product; cessation of contraception after this point should be discussed with a responsible physician
• •Females of childbearing potential must also refrain from egg cell donation for 180 days after the final dose of investigational product;
• •* Females of childbearing potential are defined as those who are not surgically sterile (ie, bilateral tubal ligation, bilateral oophorectomy, or complete hysterectomy) or postmenopausal (defined as 12 months with no menses without an alternative medical cause)
• •* A highly effective method of contraception is defined as one that results in a low failure rate (ie, less than 1% per year) when used consistently and correctly; the acceptable methods of contraception are: barrier method (e.g. male condom with spermicide, copper T intrauterine device, or levonorgestrel-releasing intrauterine system - Mirena) or hormonal methods (e.g. implants, hormone shot or injection, combined pill, minipill, or patch); non-sterilized males who are sexually active with a female partner of childbearing potential must use a highly effective method of contraception from days 1-180 post last dose; in addition, they must refrain from sperm donation for 180 days after the final dose of investigational product
• •The ability to interrupt nonsteroidal antiinflammatory drug (NSAIDS) 2 days before (5 days for long-acting NSAIDs), the day of, and 2 days following administration of pemetrexed
• •The ability to take folic acid, vitamin B12, and dexamethasone according to protocol