Patient description: A 57-year-old man was admitted to the clinic because of weight loss and persistent dry cough 4 months ago. Chest computed topography showed bilateral multiple infiltrates in the upper lobes and thickened bronchial walls. There is a documented positive serum MPO-ANCA in his medical record. Transbronchial biopsy revealed necrotic granulomas with multinucleated giant cells and the Wegener's granulomatosis was diagnosed for him. He is treating with corticosteroid and cyclophosphamides since 4 months ago. His Birmingham Vasculitis Activity Score (BVAS) is above 4 since the beginning of his disease. His last physical exam and lab study was performed yesterday and showed the results bellow: A wellbeing, well-nourished man, non-icteric, cooperative and alert Weight: 73 kg Height: 177 BP: 120/80 HR: 90/min RR: 22/min Hgb: 13 g/dl WBC: 8000 /mm3 (Neutrophil: 2700/mm3) Plt: 300000 /ml AST: 40 U/L ALT: 56 U/L Alk P: 147 U/L Bill total: 1.2 mg/dl ESR: 120 mm/hr MPO-ANCA: 153 EU

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Transitional Cell Carcinoma Bladder Carcinoma Urothelial Carcinoma Histological or cytological proof of transitional cell carcinoma (TCC) of the bladder, urethra, ureter, or renal pelvis (urothelial carcinoma). Histology may be mixed, but still requires a component of TCC Measurable disease according to and obtained by imaging within 30 days prior to registration for protocol therapy Must be ineligible for cisplatin, based on the following, within 30 days prior to registration for protocol therapy Prior radiation therapy is allowed to < 25% of the bone marrow Written informed consent and HIPAA authorization for release of personal health information Age > 18 years at the time of consent Females of childbearing potential and males must be willing to use an effective method of contraception (hormonal or barrier method of birth control; abstinence) from the time consent is signed until 8 weeks after treatment discontinuation Females of childbearing potential must have a negative pregnancy test within 7 days prior to prior to registration for protocol therapy Females must not be breastfeeding  No prior chemotherapy for metastatic disease. Prior chemotherapy in the neoadjuvant/adjuvant setting is allowed if completed at least 12 months prior to registration for protocol therapy No active CNS metastases or leptomeningeal metastases. Patients with neurological symptoms must undergo a head CT scan or brain MRI to brain metastasis No prior malignancy is allowed except for adequately treated basal cell or adequately treated squamous cell skin cancer, in situ cervical cancer, Gleason ≤ grade 7 prostate cancers (treated definitively with no evidence of PSA progression), or other cancer for which the patient has been disease-free for at least 5 years No treatment with any anticancer therapy or investigational agent within 30 days prior to registration for protocol therapy No known hypersensitivity to any protocol treatment No prior treatment with mTOR inhibitor (sirolimus, temsirolimus, everolimus) No history of immunization with attenuated live vaccines within one week prior to registration for protocol therapy or during study period No severely impaired lung function as defined as spirometry and DLCO that is 50% of the normal predicted value and/or 02 saturation that is 88% or less at rest on room air No uncontrolled diabetes as defined by fasting serum glucose >1.5 x ULN No active (acute or chronic) or uncontrolled severe infections