Maintenance treatment with gemcitabine have a promising activity on metastatic bladder cancer survival

Abstract

Objective: To investigate the effects of gemcitabine maintenance treatment on survival in patients with metastatic bladder cancer. Material and methods:Gemcitabine maintenance monotherapy was administered following the standard platinum-gemcitabine therapy in patients with metastatic bladder cancer. Patients who had responded to standard treatment received maintenance gemcitabine therapy as 1000 mg/m 2 on days 1 and 8 every three weeks until progression or development of unacceptable toxicity. The following clinical factors were noted: performance status, age, sex, stage, site of metastasis, choice of cisplatin-gemcitabine or carboplatin-gemcitabine, response rates to the initial chemotherapy. Progression-free survival (PFS) and overall survival (OS) for standard treatment, and following gemcitabine monotreatment and for maintenance gemcitabine therapy were calculated using Kaplan-Meier method.Results: A total of 88 patients with metastatic bladder cancer treated between February 2009 to October 2015 were evaluated retrospectively and 23 patients (26.1%) who had responded to six cycles of platinumgemcitabine treatment were included in this study. Maintenance gamcitabine was administered for a median of 7 times (range 3-14 times). Grade 3 hematotoxicity according to the criteria of the Common Terminology Criteria of Adverse Events was observed in 7 (30.4%) patients. Median PFS of patients was 46 (range: 30-82) weeks for platinum-based treatment plus maintenance gemcitabine therapy. A higher median PFS was obtained in patients who were <65 year-olds, without organ metastasis with objective response rate, however, it was statistically insignificant. Conclusion:Gemcitabine maintenance therapy in metastatic bladder cancer patients who did not shown progression after the standard platinum-gemcitabine treatment contributes to survival and presents low toxicity profile, when compared to historical controls.

Assessment of Outcomes of Maintenance Gemcitabine after Standard Chemotherapy in Metastatic Bladder Transitional Cell Carcinoma Patients

“…In our study, the visceral metastasis was not statistically significant prognostic parameter was as in Kus and Aktas (14) study (P=0.482). On the contrary, Muto et al (12) study demonstrated that the presence of visceral metastases (P=0.007), the success of initial chemotherapy (P=0.018), and GEM maintenance therapy (P<0.001) were all statistically significant predictors of DSS.…”

“…The maintenance treatment in our study, the median (range) of number of cycles was (1-12)cycles with median dose of cycle (1000-1800mg) while Muto et al (12) the median was (2-49 ) cycles with median dose of cycle (500-1795mg), Kus and Aktas (14) the Median 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) cycles with median dose of cycle (500-1800mg) and Lehmann et al (15) reported administrating 41 cycles of GEM maintenance monotherapy with cumulative total dose of gemcitabine 88.500mg.…”

“…In Kus and Aktas (14) , patients were retrospectively enrolled from February 2009 through October 2015. After receiving platinum-based therapy and maintenance gemcitabine monotherapy, the median progression-free survival (PFS) was 46 weeks (range, 30-82 weeks).…”

Up-regulation of DRAM2 promotes tolerance of bladder transitional cell carcinoma to gemcitabine

“…Therefore, the development of new therapies is still desirable. Gemcitabine, a nucleoside antimetabolite that inhibits DNA synthesis, is one of the most often used anticancer drugs in the treatment of BTCC [ 4 , 5 ]. However, the development of chemoresistance for gemcitabine has become one of the most important reasons for treatment failure and has resulted in relapse, metastasis or patient death [ 6 ].…”