1. Third-Line Chemotherapy for Metastatic Urothelial Cancer
- Author
-
Guru Sonpavde, Sabino De Placido, Alfonso Benincasa, Carlo Buonerba, Dario Ribera, Matteo Ferro, Ottavio De Cobelli, Teresa Bellelli, Giuseppe Lucarelli, Concetta Romano, Vittorino Montanaro, and Giuseppe Di Lorenzo
- Subjects
Oncology ,Urologic Neoplasms ,medicine.medical_specialty ,Time Factors ,Cyclophosphamide ,medicine.medical_treatment ,Population ,Observational Study ,Salvage therapy ,Disease-Free Survival ,Hemoglobins ,chemistry.chemical_compound ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Neoplasm Metastasis ,education ,Serum Albumin ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Salvage Therapy ,Chemotherapy ,education.field_of_study ,Vinflunine ,Proportional hazards model ,business.industry ,Hazard ratio ,General Medicine ,Prognosis ,Gemcitabine ,Surgery ,chemistry ,Quality of Life ,business ,Research Article ,medicine.drug - Abstract
The prognosis of locally advanced (T3/T4 or N1) and metastatic disease urothelial carcinoma is poor. In this retrospective study, we reviewed data about patients receiving third-line chemotherapy for metastatic disease, in view of the lack of data in this setting. We retrospectively analyzed medical records of patients with a pathologic diagnosis of urothelial carcinoma treated with systemic chemotherapy for metastatic disease at 4 participating Institutions between January, 2010, and January, 2015. Cox proportional hazards regression was used to evaluate the association of the chemotherapy agent used versus others with overall survival, adjusted for 5 externally validated prognostic factors in advanced urothelial carcinoma. Of 182 patients that received first-line chemotherapy/adjuvant chemotherapy as defined above, 116 patients (63.73%) received second-line salvage treatment. Fifty-two patients were finally included in this analysis, whereas 9 were excluded due to missing data. Third-line chemotherapy was based on cyclophosphamide, platinum, vinflunine, taxanes, and gemcitabine in 16, 12, 11, 10, and 3 patients, respectively. Median PFS (progression-free survival) and OS (overall survival) of the population were 13 (10–17) and 31 (28–36) weeks. Single-agent cyclophosphamide was associated with a PFS of 18 (13–22) and an OS of 38 (33–41) weeks, whereas platinum-based combinations were associated with a PFS of 5 weeks and an OS of 8 weeks. Multivariate analysis showed improved survival in patients treated with cyclophosphamide (hazard ratio (HR) = 0.42; 95% CI: 0.20–0.89; P = 0.025) and a worse survival in those treated with platinum-based regimens (HR: 4.37; 95% CI = 1.95–9.77; P
- Published
- 2015
- Full Text
- View/download PDF