Combination of Gemcitabine and Paclitaxel is a Favorable Option for Patients with Advanced or Metastatic Urothelial Carcinoma Previously Treated with Cisplatin-based Chemotherapy

Ikeda, Masaomi; Matsumoto, Kazumasa; Tabata, Ken‐ichi; Minamida, Satoru; Fujita, Tetsuo; Satoh, Takefumi; Iwamura, Masatsugu; Baba, Shirō

doi:10.1093/jjco/hyr131

Cited by 19 publications

(13 citation statements)

References 36 publications

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“…Our results are in line with recent reports demonstrating that in patients treated with a second-line combination regimen including GP regimen for mUC, the ORR was 8.6%–41.7% and median OS was 4.8–12.4 months. 8 , 19 , 21 , 27 – 31 Compared with these results, the oncological outcomes of our study in elderly patients were encouraging with regard to a durable response rate and survival, therefore, supporting the use of second-line GD therapy in elderly patients with a comorbidity.…”

Section: Discussionsupporting

confidence: 64%

Gemcitabine and docetaxel as second-line chemotherapy in elderly patients with metastatic urothelial carcinoma: a retrospective analysis

Naiki¹,

Iida²,

Etani³

et al. 2018

CMAR

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BackgroundThe objective of this study was to evaluate the efficacy of a combination of gemcitabine and docetaxel (GD) as a second-line treatment for elderly patients with metastatic urothelial carcinoma (mUC).Patients and methodsA total of 122 patients with mUC who were previously treated with platinum-based chemotherapy received second-line GD therapy from July 2010 to June 2016. This consisted of 800 mg/m2 gemcitabine and 40 mg/m2 docetaxel on days 1 and 8 in each 21-day cycle. Using pooled cumulative data, we divided patients into the following three groups based on age: <65 years (Group A), from 65 to 74 years (Group B), and ≥75 years (Group C), and then the data were retrospectively analyzed. All patients were evaluated for treatment-related toxicities and assessed at every cycle by imaging studies. Kaplan–Meier curves were used for survival and recurrence analyses. Furthermore, potential prognostic factors for progression-free survival (PFS) and overall survival (OS) were assessed via univariate and multivariate Cox regression analyses.ResultsThe median follow-up period was 8.2 months (range: 2.1–100). The median number of treatment cycles was three (range: 1–16) in Group A, three (1–15) in Group B, and two (1–11) in Group C. The objective response rate was not significantly different between the three groups. In addition, PFS and OS from the start of second-line GD therapy were also not significantly different. According to univariate and multivariate analyses of the second-line GD-treated cohort, a good performance status was the only prognostic factor for PFS and OS. In Group C, myelosuppression including predominant neutropenia and anemia, fatigue, and nausea were the main common adverse events. However, the incidence of neutropenia and a reduction in platelets were not significantly different between the three groups. Treatment-related deaths did not occur in this study.ConclusionIn this study, GD combination therapy as a second-line treatment for mUC resulted in favorable tumor responses and few treatment-related toxicities, even among elderly patients.

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Section: Discussionsupporting

confidence: 64%

Gemcitabine and docetaxel as second-line chemotherapy in elderly patients with metastatic urothelial carcinoma: a retrospective analysis

Naiki¹,

Iida²,

Etani³

et al. 2018

CMAR

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“…Several studies have examined the various prognostic factors of patients. Buti et al identified nine studies (29)(30)(31)(32)(33)(34)(35)(36)(37)) that aimed at evaluate the prognostic factors of 1,273 patients in a second-line treatment setting. In most studies, PS, Hb, and visceral metastasis were identified as the main independent prognostic factors for OS (38).…”

Section: Discussionmentioning

confidence: 99%

The combination of paclitaxel and carboplatin as second-line chemotherapy can be a preferred regimen for patients with urothelial carcinoma after the failure of gemcitabine and cisplatin chemotherapy

et al. 2017

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Abstract. There is no established standard second-line chemotherapy after the failure of the first-line cisplatin-based chemotherapy for patients with advanced or metastatic urothelial carcinoma. With regards to second-line chemotherapy, methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) was used from July 2009 onwards, and paclitaxel and carboplatin (TC) was introduced in April 2014 at the National Kyushu Cancer Center. The present study aimed to assess the prognostic factors for overall survival (OS) in second-line treatment that included best supportive care (BSC), and the tolerability and efficacy of TC chemotherapy. In total, 52 patients who were confirmed to have disease progression with first-line gemcitabine and cisplatin (GC) between June 2009 and November 2016 were enrolled in the current study. In addition, 28 patients selected BSC as second-line treatment, while 24 patients received second-line chemotherapy (MVAC, n=8; TC, n=16). The median OS for BSC, MVAC and TC was 2.8, 5.4, and 12.7 months, respectively. The difference between BSC and MVAC was not statistically significant (P=0.596). However, the difference between BSC and TC was statistically significant after Bonferroni correction (P=0.002). Multivariate analyses revealed that anemia [hazard ratio (HR), 7.047; 95% confidence interval (CI), 1.553-35.636; P= 0.011], the presence of visceral metastasis (HR, 4.174; 95% CI, 1.506-13.429; P= 0.005) and second-line treatment (TC HR, 0.296; 95% CI, 0.124-0.636; P= 0.003) were independent prognostic factors. TC achieved an 18.7% overall response rate and a 56.2% disease control rate. Myelosuppression was the most common grade ≥3 toxicity, but no treatment-associated mortalities occurred during the study period. TC was associated with favorable benefits and safety, and may be considered a preferred regimen after the failure of GC.

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“…Various GEM and PTX regimens have been described in previous reports. The most representative and common regimen is administration of GEM on day 1, 8, and 15 and PTX on day 1 [11, 15, 17, 18]. In another report, the day 15 GEM dose was omitted in 31 % of courses, almost always due to myelosuppression [11].…”

Section: Discussionmentioning

confidence: 99%

Use of low-dose combined therapy with gemcitabine and paclitaxel for advanced urothelial cancer patients with resistance to cisplatin-containing therapy: a retrospective analysis

Miyata

Nomata

Ohba

et al. 2012

Cancer Chemother Pharmacol

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PurposeThe prognosis of patients with advanced and recurrent urothelial cancer (UC) is poor. Although cisplatin (CDDP)-containing chemotherapy is the most effective regimen in these patients, there is no other established chemotherapeutic regimen. We administered combination therapy with low-dose gemcitabine (GEM) and paclitaxel (PTX), named low-dose gemcitabine–paclitaxel (LD-GP) therapy, as salvage therapy for these patients. The aim was to evaluate the anti-tumoral effects, relief of pain, and toxicity of LD-GP therapy in patients with resistance to CDDP-containing therapy.Patients and methodsThirty-five patients with advanced UC, previously treated with CDDP-containing regimens, were treated with LD-GP therapy (GEM, 700 mg/m2 + PTX, 70 mg/m2 on day 1 and 8, repeated every 28 days). Pain was measured on a visual analog scale before and after treatment. Pain relief and survival were compared between this and other treatment regimens.ResultsNone of the patients had complete response to LD-GP therapy. Partial response and stable disease were seen in 25.7 and 62.9 % of patients, respectively. Kaplan–Meier curves showed better survival in patients with LD-GP therapy than with others (p = 0.034). Twenty-eight patients (80.0 %) had adequate pain relief, and only two patients needed to increase their analgesics. Other regimens demonstrated pain relief in 30.4 % of patients. Common toxicities included leukopenia, with five patients requiring granular colony-stimulating factor therapy (14.3 %). The most common non-hematologic toxicity was fatigue (n = 7, 17.1 %).ConclusionsLD-GP therapy is feasible and well tolerated as salvage therapy in patients with advanced UC with resistance to CDDP-containing therapy.

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Combination of Gemcitabine and Paclitaxel is a Favorable Option for Patients with Advanced or Metastatic Urothelial Carcinoma Previously Treated with Cisplatin-based Chemotherapy

Cited by 19 publications

References 36 publications

Gemcitabine and docetaxel as second-line chemotherapy in elderly patients with metastatic urothelial carcinoma: a retrospective analysis

Gemcitabine and docetaxel as second-line chemotherapy in elderly patients with metastatic urothelial carcinoma: a retrospective analysis

The combination of paclitaxel and carboplatin as second-line chemotherapy can be a preferred regimen for patients with urothelial carcinoma after the failure of gemcitabine and cisplatin chemotherapy

Use of low-dose combined therapy with gemcitabine and paclitaxel for advanced urothelial cancer patients with resistance to cisplatin-containing therapy: a retrospective analysis

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