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Takeyama Y, Kato M, Nishihara C, Yamasaki T, Iguchi T, Tamada S, Kuratsukuri K, Nakatani T. Comparison of efficacy and toxicity of second-line combination chemotherapy regimens in patients with advanced urothelial carcinoma. Int J Clin Oncol 2018; 23:944-950. [PMID: 29785621 DOI: 10.1007/s10147-018-1288-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/01/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and toxicities of second-line chemotherapy regimens with docetaxel and gemcitabine (GD), or paclitaxel and gemcitabine (GP) for advanced or metastatic urothelial carcinoma (UC) that did not respond to first-line platinum-based chemotherapy. METHODS From 2002 to 2017, 78 patients with metastatic UCs that progressed after platinum-based chemotherapy were treated with either GD (n = 41) or GP (n = 37). We compared these two different regimens by analyzing their efficacy and toxicities in a retrospective manner. RESULTS Of the 78 patients enrolled in this study, it was possible to determine treatment efficacy in 70; the proportion of patients with objective response and disease control were 8.6 (9/70) and 54.3% (38/70), respectively. The median progression-free survival and overall survival in the total population (GP and GD) were 3.5 (95% CI 0.6-53.3) and 9.6 months (95% CI 1.2-53.3), respectively. There was no significant difference between the two regimens (GD or GP) regarding survival outcomes. Treatment-related adverse events were mostly manageable, but one patient died as a result of febrile neutropenia. The presence of liver metastasis and anemia (Hb < 10.0 g/dl) was prognostic factors for worse survival. CONCLUSIONS Combination chemotherapy with either GP or GD was a favorable and well-tolerated second-line treatment regimen for patients with advanced or metastatic UC following the failure of a platinum-based regimen. Further study using a large prospective cohort is needed to identify patients who will benefit from second-line combination therapy.
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Affiliation(s)
- Yuji Takeyama
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Minoru Kato
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan.
| | - Chikako Nishihara
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Takeshi Yamasaki
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Taro Iguchi
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Satoshi Tamada
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Katsuyuki Kuratsukuri
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Tatsuya Nakatani
- Department of Urology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
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Efficacy of post-nephroureterectomy cisplatin-based adjuvant chemotherapy for locally advanced upper tract urothelial carcinoma: a multi-institutional retrospective study. World J Urol 2017; 35:1569-1575. [PMID: 28397000 DOI: 10.1007/s00345-017-2032-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy of adjuvant systemic chemotherapy for locally advanced (pT3-4pN0/xM0) upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS We retrospectively reviewed the medical records of 109 patients with pT3-4pN0/xM0 UTUC who had undergone radical nephroureterectomy between 1996 and 2013 at our four institutions. The patients were divided into two groups: those who received adjuvant chemotherapy (AC group) and those who did not (surgery-alone: SA group). All chemotherapy regimens were cisplatin-based. Cox proportional hazards regression models addressed the associations between clinicopathological factors and recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS Forty-three (39.5%) out of the 109 patients underwent one to four cycles of adjuvant chemotherapy after nephroureterectomy. Median follow-up was 46.5 months. There were no significant differences in the background characteristics of the two groups, except for age. Recurrence developed in 11 (25.6%) and 29 (43.9%) patients in the AC and SA groups, respectively. Ultimately, six (14.0%) and 18 (27.3%) patients in the AC and SA groups, respectively, died of disease progression. On univariate analysis, hydronephrosis, nuclear grade, lymphovascular invasion, and adjuvant chemotherapy were significantly associated with both RFS and CSS. Charlson comorbidity index was associated only with CSS. On multivariate analysis, adjuvant chemotherapy was the only independent factor associated with improved RFS (p = 0.0178, HR = 0.41). Moreover, adjuvant chemotherapy (p = 0.0375, HR = 0.33), lower nuclear grade (p = 0.0070), and the absence of hydronephrosis (p = 0.0493) were independently associated with better CSS. CONCLUSION Locally advanced (pT3-4pN0/xM0) UTUC patients who underwent cisplatin-based adjuvant chemotherapy demonstrated better RFS and CSS than those without adjuvant chemotherapy.
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Xue C, An X, Cao Y, Chen T, Yang W, Deng Y, Han H, Teng X, Zhou F, Shi Y. Effectiveness of capecitabine with or without docetaxel therapy for the treatment of patients with advanced urothelial carcinoma: a single-institution experience. Oncotarget 2016; 7:63722-63729. [PMID: 27577082 PMCID: PMC5325398 DOI: 10.18632/oncotarget.11641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/29/2016] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness and toxicity of capecitabine (C) chemotherapy regimen with or without (w/o) docetaxel (D) in patients with advanced urothelial carcinoma (UC). RESULTS Clinical benefit rate were similar in two arms (C arm vs DC arm: 38.9% vs 45.5%, p = 0.411). There were two cases achieved partial response in DC arm. In C arm, the median PFS was 3.0 months (95% CI 2.5-3.5 months) and median OS was 11.3 months (95% CI 8.6-14.1 months). In DC arm, the median PFS was 2.2 months (95% CI 1.7-2.7 months) and median OS was 18 months (95% CI 6.8-29.9 months). Adverse events were mostly acceptable, including myelosuppession, hand-foot syndrome and mucositis. Anemia and leukopenia was found more in the DC arm than in the C arm. MATERIALS AND METHODS This is a one-center, observational, retrospective study. From April 2009 to March 2015, a total of 29 patients with metastatic UC were included in the study. Survivals, response rates and toxicities were collected retrospectively. CONCLUSIONS The result showed the activity and toxicity of C w/o D. As DC treatment did not reveal better outcome, C or D single-agent might be an option in platinum-failed patients with advanced urothelial carcinoma. Further clinical trials are warranted.
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Affiliation(s)
- Cong Xue
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xin An
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ye Cao
- Department of GCP, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Tanhuan Chen
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wei Yang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yingfei Deng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Hui Han
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xiaoyu Teng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Fangjian Zhou
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yanxia Shi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
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Sonpavde G, Pond GR, Rosenberg JE, Bajorin DF, Choueiri TK, Necchi A, Di Lorenzo G, Bellmunt J. Improved 5-Factor Prognostic Classification of Patients Receiving Salvage Systemic Therapy for Advanced Urothelial Carcinoma. J Urol 2015; 195:277-82. [PMID: 26292040 DOI: 10.1016/j.juro.2015.07.111] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE Prognostic factors in patients receiving salvage systemic therapy for advanced urothelial carcinoma include performance status, liver metastasis, hemoglobin and time since chemotherapy. We investigated the impact of albumin, and neutrophil, lymphocyte and platelet counts. MATERIALS AND METHODS Patient level data from 10 phase II trials were used. Cox proportional hazards regression was applied to evaluate associations with overall survival. An optimal regression model was constructed using forward stepwise selection and risk groups were defined using the number of adverse factors. Trial was a stratification factor. External validation was done in a separate data set of 5 salvage phase II trials. RESULTS Discovery data were obtained on 708 patients. After adjustment for the 4 known factors a platelet count of the upper limit of normal or greater and albumin less than the lower limit of normal were significant poor prognostic factors. Only the addition of albumin was externally validated. For 0 or 1, 2 and 3 or greater risk factors median overall survival was 8.9, 6.4 and 4.5 months in 207, 171 and 113 patients in the discovery data set of 491, and 10.6, 10.0 and 7.0 months in 73, 47 and 47 patients, respectively, in the validation data set of 167. By adding albumin the c-index improved from 0.610 to 0.639 in the discovery set and from 0.616 to 0.646 in the validation set. CONCLUSIONS Albumin was externally validated as a prognostic factor for overall survival after accounting for time from prior chemotherapy, hemoglobin, performance status and liver metastasis status in patients receiving salvage systemic therapy for advanced urothelial carcinoma. The discovery of molecular prognostic factors is a priority to further enhance this new preferred 5-factor clinical prognostic model.
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Affiliation(s)
- Guru Sonpavde
- University of Alabama-Birmingham Comprehensive Cancer Center, Birmingham, Alabama.
| | | | | | - Dean F Bajorin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Sonpavde G, Pond GR, Choueiri TK, Mullane S, Niegisch G, Albers P, Necchi A, Di Lorenzo G, Buonerba C, Rozzi A, Matsumoto K, Lee JL, Kitamura H, Kume H, Bellmunt J. Single-agent Taxane Versus Taxane-containing Combination Chemotherapy as Salvage Therapy for Advanced Urothelial Carcinoma. Eur Urol 2015; 69:634-641. [PMID: 26264159 DOI: 10.1016/j.eururo.2015.07.042] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Single-agent taxanes are commonly used as salvage systemic therapy for patients with advanced urothelial carcinoma (UC). OBJECTIVE To study the impact of combination chemotherapy delivering a taxane plus other chemotherapeutic agents compared with single-agent taxane as salvage therapy. DESIGN, SETTING, AND PARTICIPANTS Individual patient-level data from phase 2 trials of salvage systemic therapy were used. INTERVENTIONS Trials evaluating either single agents (paclitaxel or docetaxel) or combination chemotherapy (taxane plus one other chemotherapeutic agent or more) following prior platinum-based therapy were used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Information regarding the known major baseline prognostic factors was required: time from prior chemotherapy, hemoglobin, performance status, albumin, and liver metastasis status. Cox proportional hazards regression was used to evaluate the association of prognostic factors and combination versus single-agent chemotherapy with overall survival (OS). RESULTS AND LIMITATIONS Data were available from eight trials including 370 patients; two trials (n=109) evaluated single-agent chemotherapy with docetaxel (n=72) and cremophor-free paclitaxel (n=37), and six trials (n=261) evaluated combination chemotherapy with gemcitabine-paclitaxel (two trials, with n=99 and n=24), paclitaxel-cyclophosphamide (n=32), paclitaxel-ifosfamide-nedaplatin (n=45), docetaxel-ifosfamide-cisplatin (n=26), and paclitaxel-epirubicin (n=35). On multivariable analysis after adjustment for baseline prognostic factors, combination chemotherapy was independently and significantly associated with improved OS (hazard ratio: 0.60; 95% confidence interval, 0.45-0.82; p=0.001). The retrospective design of this analysis and the trial-eligible population were inherent limitations. CONCLUSIONS Patients enrolled in trials of combination chemotherapy exhibited improved OS compared with patients enrolled in trials of single-agent chemotherapy as salvage therapy for advanced UC. Prospective randomized trials are required to validate a potential role for rational and tolerable combination chemotherapeutic regimens for the salvage therapy of advanced UC. PATIENT SUMMARY This retrospective study suggests that a combination of chemotherapy agents may extend survival compared with single-agent chemotherapy in selected patients with metastatic urothelial cancer progressing after prior chemotherapy.
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Affiliation(s)
- Guru Sonpavde
- UAB Comprehensive Cancer Center, Birmingham, AL, USA.
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Stephanie Mullane
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | | | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Carlo Buonerba
- Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero In Vulture, Italy
| | - Antonio Rozzi
- Istituto Neurotraumatologico Italiano, Grottaferrata, Italy
| | | | | | | | | | - Joaquim Bellmunt
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Taguchi S, Nakagawa T, Uemura Y, Matsumoto A, Nagase Y, Kawai T, Tanaka Y, Yoshida K, Yamamoto S, Enomoto Y, Nose Y, Sato T, Ishikawa A, Fujimura T, Fukuhara H, Kume H, Homma Y. Validation of major prognostic models for metastatic urothelial carcinoma using a multi-institutional cohort of the real world. World J Urol 2015; 34:163-71. [PMID: 26135306 DOI: 10.1007/s00345-015-1631-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several prognostic models predicting survival of patients with metastatic urothelial carcinoma (UC) have been developed; however, of them, the first model by Bajorin in 1999 is still the most representative and widely used, and validations of newer models are lacking. This study aimed to validate three major prognostic models for metastatic UC constructed based on clinical trials. METHODS We reviewed 200 patients with metastatic UC who received first-line chemotherapy at our five affiliate institutions between 2003 and 2011. Using this multi-institutional cohort, we validated the following models: the "Bajorin model," a model consisting of visceral metastasis and performance status; the "Apolo model," a nomogram including visceral metastasis, performance status, albumin and hemoglobin; and the "Galsky model," a nomogram including leukocyte count, number of sites of visceral metastases, site of primary tumor, performance status and lymph node metastasis. Harrell's c-index was calculated for each model. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Among 200 patients, 171 (85.5%) died during the follow-up, with a median survival of 12.0 months. Multivariate analysis demonstrated ECOG performance status, visceral metastasis and leukocyte count to be independent predictors of overall survival. C-index results (95% confidence interval) were Bajorin: 0.86 (0.74-0.95); Apolo: 0.89 (0.78-0.98); and Galsky: 0.82 (0.69-0.93). CONCLUSIONS All models were demonstrated to have high external validities in real-world patients, and of them, the "Apolo model" achieved the highest c-index in the present population. Further studies with larger populations are needed for establishment of the next standard model.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yukari Uemura
- Central Coordinating Unit, Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiko Matsumoto
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasushi Nagase
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yoshinori Tanaka
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kanae Yoshida
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Sachi Yamamoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yutaka Enomoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yorito Nose
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Toshikazu Sato
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Akira Ishikawa
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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