Highlights
- •Optimal chemotherapy for cisplatin-treated metastatic urothelial carcinoma is unclear.
- •There is no significant difference in outcomes between platinum retreatment and non-platinum chemotherapy.
- •If over a year has elapsed from cisplatin-based chemotherapy for localized disease, return to platinum is superior over non-platinum regimens.
- •This data is also relevant for those patients who are not ideal candidates for immune-oncology therapy.
Abstract
Background
Optimal chemotherapy for patients who received cisplatin for localized urothelial
carcinoma (UC) and develop metastatic disease is unclear. We compared the efficacy
of platinum-based (PBC) versus non–platinum-based (NPBC) first-line chemotherapy for
metastasis.
Patients and Methods
Data were collected from the Retrospective International Study of Cancers of the Urothelial
Tract (RISC), a database of 3024 patients from 28 international academic centers from
2005 to 2012. Patient inclusion criteria included: (1) predominant UC; (2) any primary
tumor site; (3) cT2-4, cN0-N2, cM0; (4) prior receipt of perioperative/radiation cisplatin-containing
chemotherapy; and (5) receipt of cytotoxic chemotherapy in the first-line metastatic
setting. Multivariate Cox proportional hazards models were used to show progression-free
survival (PFS) and overall survival (OS) from the first day of chemotherapy for metastatic
disease to date of censor.
Results
Eligibility criteria was met by 132 patients (n = 74 PBC; n = 58 NPBC). The median
OS was 8.13 months (interquartile range, 4.87-16.64 months) and 8.77 months (interquartile
range, 4.01-13.49 months) for PBC and NPBC, respectively. Neither OS (hazard ratio
[HR], 1.04; 95% confidence interval [CI], 0.64-1.69; P = .87) nor PFS (HR, 0.86; 95% CI, 0.56-1.31; P = .48) differed for PBC versus NPBC. However, for patients who received chemotherapy
more than a year after perioperative/radiation chemotherapy, OS was superior for PBC
over NPBC (HR, 0.31; 95% CI, 0.10-0.92; P = .03).
Conclusions
There is no significant outcome difference between PBC and NPBC in patients with metastatic
UC who previously received cisplatin-based chemotherapy for localized disease. However,
if over a year has elapsed, return to PBC is associated with superior OS.
Keywords
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Article Info
Publication History
Published online: November 13, 2020
Accepted:
October 30,
2020
Received in revised form:
October 27,
2020
Received:
July 18,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
