Impact of the number of cycles of platinum-based first-line chemotherapy for advanced urothelial carcinoma
Impact of the number of cycles of platinum-based first-line chemotherapy for advanced urothelial carcinoma
PURPOSE: To evaluate the impact of number of cycles of platinum-based first-line chemotherapy <6 versus the conventional ≥6 on survival of metastatic urothelial carcinoma (UC).
MATERIALS AND METHODS: The Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC) database was employed. The association of the number of cycles of chemotherapy with overall survival (OS) was investigated by Cox multiple regression analysis after controlling for recognized prognostic factors. We excluded patients receiving <3 or >9 cycles of platinum chemotherapy to reduce confounding factors. The primary analysis was a comparison of OS with 3-5 cycles versus 6-9 cycles using 6-month landmark analysis when 281 death events were observed.
RESULTS: Of 1,020 patients in RISC, 472 who received cisplatin (n=338) or carboplatin (n=134) were evaluable. A total of 157 patients received 3-5 cycles (median 4) and 315 received 6-9 cycles (median 6). There was no significant difference in OS between 3-5 and 6-9 cycles (HR 1.02, 95%CI: 0.78-1.33, p=0.91). No significant interactions were observed with type of platinum (p=0.09) and completed planned chemotherapy (p=0.56). Limitations of a hypothesis-generating retrospective analysis apply.
CONCLUSIONS: Four cycles of platinum based first-line chemotherapy appear adequate and do not significantly compromise survival of patients with advanced UC. The omission of excessive cycles may avoid unnecessary cumulative toxicities and facilitate better transition to second-line therapy and investigational switch maintenance therapy strategies. These results require prospective validation, but may impact practice in selected patients.
Journal Article
Sonpavde, G.P.
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Mariani, L.
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Lo Vullo, S.
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Raggi, D.
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Giannatempo, P.
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Bamias, A.
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Crabb, S.J.
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Bellmunt, J.
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Yu, E.Y.
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Niegisch, G.
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Vaishampayan, U.N.
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Theodore, C.
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Berthold, D.R.
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Srinivas, S.
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Sridhar, S.S.
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Plimack, E.R.
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Rosenberg, J.E.
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Powles, T.
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Galsky, M.D.
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Necchi, A.
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Sonpavde, G.P.
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Mariani, L.
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Lo Vullo, S.
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Raggi, D.
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Giannatempo, P.
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Bamias, A.
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Crabb, S.J.
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Bellmunt, J.
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Yu, E.Y.
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Niegisch, G.
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Vaishampayan, U.N.
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Theodore, C.
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Berthold, D.R.
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Srinivas, S.
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Sridhar, S.S.
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Plimack, E.R.
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Rosenberg, J.E.
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Powles, T.
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Galsky, M.D.
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Necchi, A.
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Sonpavde, G.P., Mariani, L., Lo Vullo, S., Raggi, D., Giannatempo, P., Bamias, A., Crabb, S.J., Bellmunt, J., Yu, E.Y., Niegisch, G., Vaishampayan, U.N., Theodore, C., Berthold, D.R., Srinivas, S., Sridhar, S.S., Plimack, E.R., Rosenberg, J.E., Powles, T., Galsky, M.D. and Necchi, A.
(2018)
Impact of the number of cycles of platinum-based first-line chemotherapy for advanced urothelial carcinoma.
The Journal of Urology.
(doi:10.1016/j.juro.2018.07.035).
Abstract
PURPOSE: To evaluate the impact of number of cycles of platinum-based first-line chemotherapy <6 versus the conventional ≥6 on survival of metastatic urothelial carcinoma (UC).
MATERIALS AND METHODS: The Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC) database was employed. The association of the number of cycles of chemotherapy with overall survival (OS) was investigated by Cox multiple regression analysis after controlling for recognized prognostic factors. We excluded patients receiving <3 or >9 cycles of platinum chemotherapy to reduce confounding factors. The primary analysis was a comparison of OS with 3-5 cycles versus 6-9 cycles using 6-month landmark analysis when 281 death events were observed.
RESULTS: Of 1,020 patients in RISC, 472 who received cisplatin (n=338) or carboplatin (n=134) were evaluable. A total of 157 patients received 3-5 cycles (median 4) and 315 received 6-9 cycles (median 6). There was no significant difference in OS between 3-5 and 6-9 cycles (HR 1.02, 95%CI: 0.78-1.33, p=0.91). No significant interactions were observed with type of platinum (p=0.09) and completed planned chemotherapy (p=0.56). Limitations of a hypothesis-generating retrospective analysis apply.
CONCLUSIONS: Four cycles of platinum based first-line chemotherapy appear adequate and do not significantly compromise survival of patients with advanced UC. The omission of excessive cycles may avoid unnecessary cumulative toxicities and facilitate better transition to second-line therapy and investigational switch maintenance therapy strategies. These results require prospective validation, but may impact practice in selected patients.
Text
PIIS0022534718435318
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Accepted/In Press date: 4 July 2018
e-pub ahead of print date: 4 September 2018
Keywords:
Journal Article
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Local EPrints ID: 422762
URI: http://eprints.soton.ac.uk/id/eprint/422762
ISSN: 0022-5347
PURE UUID: 198542eb-8c77-4c55-8ce4-651c252f4199
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Date deposited: 03 Aug 2018 16:30
Last modified: 16 Mar 2024 06:55
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Contributors
Author:
G.P. Sonpavde
Author:
L. Mariani
Author:
S. Lo Vullo
Author:
D. Raggi
Author:
P. Giannatempo
Author:
A. Bamias
Author:
J. Bellmunt
Author:
E.Y. Yu
Author:
G. Niegisch
Author:
U.N. Vaishampayan
Author:
C. Theodore
Author:
D.R. Berthold
Author:
S. Srinivas
Author:
S.S. Sridhar
Author:
E.R. Plimack
Author:
J.E. Rosenberg
Author:
T. Powles
Author:
M.D. Galsky
Author:
A. Necchi
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