Chemotherapy for urothelial carcinoma in renal transplantation patients: Initial results from a single center

Abstract

The aim of this study was to assess the safety and efficacy of gemcitabine plus cisplatin/carboplatin (GC/GCa) chemotherapy in renal transplantation (RT) patients with urothelial carcinoma (UC). We reviewed the records of 12 RT patients with metastatic or locally advanced UC who received chemotherapy at our institution since January, 2013. All the patients received intravenous gemcitabine (800 mg/m) on days 1, 8 and 15, plus cisplatin (70 mg/m) or carboplatin (area under the curve = 5) on day 2, every 28 days. A total of 10 patients completed all the cycles, while 1 patient discontinued treatment due to disease progression and 1 patient discontinued due to non-medical reasons. In total, 12 patients received a median of four cycles of chemotherapy. The overall response rate was 50% (4/8 cases) in patients with measurable lesions. At the time of the study, 5 patients had succumbed to the disease (overall survival, 9.2 months), while 7 patients remained alive (follow-up time, 13.3 months). The most common toxicities were myelosuppression and gastrointestinal effects. Therefore, the GC/GCa regimen was found to be effective and tolerable in RT patients with UC. However, further studies involving more patients and control groups are required to confirm our results.

Urologic malignancies in kidney transplantation

“…In this series, most patients presented with microscopic or gross hematuria and were treated with repeated transurethral bladder resection; few underwent cystectomy or nephroureterectomy. In general, however, treatment for UC is based on stage: (I) superficial bladder UC—transurethral resection of bladder tumor (TUR‐BT) with post–TUR‐BT cytoscopic surveillance and consideration for instillation of intravesical bacillus Calmette‐Guerin (BCG) therapy or mitomycin; (II) muscle‐invasive bladder UC—neoadjuvant chemotherapy and radical cystectomy with urinary diversion; (III) transplant ureter—total transplant nephroureterectomy (transplant preserving surgery has been reported with varying success) . Importantly, UC may also arise in the native upper urinary tracts (renal and ureteral), as well as the transplant renal pelvis and calyceal collecting system.…”

“…No standard of care has been established for the management of immunosuppression after treatment of UC, although no change in regimen may be appropriate with localized UC . Literature on the optimal adjuvant chemotherapeutic regimen in these patients is sparse; a small study of 22 renal transplant patients with locally advanced UC compared surgery alone to surgery followed by gemcitabine and cisplatin . The surgery‐plus‐chemotherapy group had a longer mean survival time compared with the surgery‐alone group (31 vs 14 months) but a higher incidence of hematologic toxicities requiring dose reduction .…”