Abstract
Introduction
The optimal choice of first-line chemotherapy for patients with relapse of urothelial
carcinoma (UC) after perioperative cisplatin-based chemotherapy (PCBC) is unclear.
We investigated the outcomes with cisplatin rechallenge versus a non-cisplatin regimen
in patients with recurrent metastatic UC after PCBC in a multicenter retrospective
study.
Patients and Methods
Individual patient-level data were collected for patients who had received various
first-line chemotherapy regimens for advanced UC after previous PCBC. Cox proportional
hazards models were used to investigate the prognostic ability of the type of perioperative
and first-line chemotherapy to independently affect overall survival (OS) and progression-free
survival (PFS) after accounting for known prognostic factors.
Results
Data were available for 145 patients (12 centers). The mean age was 62 years; the
Eastern Cooperative Oncology Group (ECOG) performance status (PS) was > 0 for 42.0%
of the patients. Of the 145 patients, 63% had received cisplatin-based first-line
chemotherapy. The median time from previous chemotherapy (TFPC) was 6.2 months (range,
1-154 months). The median OS was 22 months (95% confidence interval [CI], 18-27 months),
and the median PFS was 6 months (95% CI, 5-7 months). A better ECOG PS and a longer
TFPC (> 12 months vs. ≤ 12 months; hazard ratio [HR], 0.32; 95% CI, 0.20-0.52; P < .001) was prognostic for OS and PFS. Cisplatin-based chemotherapy was associated
with poor OS (HR, 1.86; 95% CI, 1.13-3.06; P = .015), which appeared to be pronounced in those patients with a TFPC of ≤ 12 months.
Retreatment with cisplatin in the first-line setting was associated with worse OS
(HR, 3.38; P < .001).
Conclusion
The results of the present retrospective analysis suggest that for patients who have
undergone previous PCBC for UC, rechallenging with cisplatin might confer a poorer
OS, especially for those with progression within < 1 year.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours.Eur J Cancer. 2006; 42: 50-54
- Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer.J Clin Oncol. 2005; 23: 4602-4608
- Preliminary results of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for transitional cell carcinoma of the urothelium.J Urol. 1985; 133: 403-407
- A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study.J Clin Oncol. 1992; 10: 1066-1073
- Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study.J Clin Oncol. 2000; 18: 3068-3077
- Role of systemic chemotherapy in urothelial urinary bladder cancer.Cancer Control. 2013; 20: 200-210
- Timing cystectomy and perioperative chemotherapy in the treatment of muscle invasive bladder cancer.Can J Urol. 2006; 13: 48-53
- Randomized phase III study comparing paclitaxel/cisplatin/gemcitabine and gemcitabine/cisplatin in patients with locally advanced or metastatic urothelial cancer without prior systemic therapy: EORTC intergroup study 30987.J Clin Oncol. 2012; 30: 1107-1113
- Optimal treatment for metastatic bladder cancer.Curr Oncol Rep. 2014; 16: 404
- Recent advances in treatment of advanced urothelial carcinoma.Curr Urol Rep. 2012; 13: 147-152
- Modified MVAC as a second-line treatment for patients with metastatic urothelial carcinoma after failure of gemcitabine and cisplatin treatment.Cancer Res Treat. 2014; 46: 172-177
- Comparative effectiveness of gemcitabine plus cisplatin versus methotrexate, vinblastine, doxorubicin, plus cisplatin as neoadjuvant therapy for muscle-invasive bladder cancer.Cancer. 2015; 121: 2586-2593
- Prognostic model for predicting survival of patients with metastatic urothelial cancer treated with cisplatin-based chemotherapy.J Natl Cancer Inst. 2013; 105: 499-503
- Time from prior chemotherapy enhances prognostic risk grouping in the second-line setting of advanced urothelial carcinoma: a retrospective analysis of pooled, prospective phase 2 trials.Eur Urol. 2013; 63: 717-723
- Cisplatin-based first-line therapy for advanced urothelial carcinoma after previous perioperative cisplatin-based therapy.Clin Genitourin Cancer. 2015; 13: 178-184
- Impact of the number of prior lines of therapy and prior perioperative chemotherapy in patients receiving salvage therapy for advanced urothelial carcinoma: implications for trial design.Clin Genitourin Cancer. 2015; 13: 71-79
- Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer protocol no. 30924.J Clin Oncol. 2001; 19: 2638-2646
Article info
Publication history
Published online: October 24, 2015
Accepted:
October 17,
2015
Received in revised form:
October 7,
2015
Received:
May 13,
2015
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.
