Survival of patients with advanced urothelial cancer treated with cisplatin-based chemotherapy

Abstract

Summary The aim of the present retrospective study was to assess long-term survival after cisplatin-based chemotherapy in 398 patients with advanced urothelial transitional cell carcinoma (TCC) treated at seven international oncological units. Various combinations of cisplatin, methotrexate, vinblastine (or vincristine) and doxorubicin were used. The complete response rate according to the WHO criteria was 17%. Partial responses were obtained in 42% of the patients. The overall cancer-related 2 year and 5 year survival rates were 21% and 11% respectively. Based on multivariate analyses, a good prognosis group could be identified comprising patients with a good performance status with disease confined to lymph nodes (14%) or patients with T4b disease only. These patients had a 28% 5 year survival rate, which, in part, has to be related to postchemotherapy consolidation treatment in patients with pelvis-confined disease (radiotherapy, 26%; total cystectomy, 11%). Fifteen patients died of chemotherapy-related complications and in 16% of the patients toxicity led to discontinuation of treatment. Modern cisplatin-based chemotherapy leads to long-term survival and cure of selected patients with advanced urothelial transitional cancer. In routine clinical practice, chemotherapy should be offered to good prognosis patients; those presenting with a good performance status and a non-metastasising T4b tumour or with metastases confined to lymph nodes. Post-chemotherapy consolidation treatment by surgery or radiotherapy should always be considered. Such chemotherapy requires oncological expertise in order to avoid unnecessary toxicity.

Metastatic Urothelial Cancer: Evaluation of Prognostic Factors and Change in Prognosis during the Last Twenty Years

“…A variety of chemotherapy regimens was administered to 59% of the patients. The present study established PS and AP as the major important prognostic factors, and confirmed that patients with liver metastases have a poor survival [4, 6, 8]. PS, AP, and presence of liver metastases were independent prognostic factors both in the group receiving chemotherapy and in patients receiving palliative radiotherapy or no treatment.…”

“…Age, sex, localization or histology of the primary tumor or primary treatment did not influence survival. Prior reports of the importance of age included patients receiving chemotherapy and have been contradictory [2, 4]. A significant impact of prior treatment and localization of the primary tumor on survival after recurrence has been demonstrated in two smaller studies [11, 28].…”

“…This could not be confirmed in the present study. The variability may be explained by the choice of factors or by the selection of patients analyzed [4, 8]. …”

“…Several factors have been shown to influence prognosis, and the results have not been uniform [2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. This variability may be explained by the choice of factors analyzed and by selection of patients.…”

Phase II multicentre study of docetaxel plus cisplatin in patients with advanced urothelial cancer

“…Moreover, after a major response to chemotherapy, a small number of patients (4.3%) remained free of disease after long-term follow-up. This percentage of long-term survivors may be increased when postchemotherapy surgery or radiotherapy is performed in selected responding patients (Fossa et al, 1996;Dodd et al, 1999). The data showed that urothelial cancer is a disease sensitive to chemotherapy.…”