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Do OA , Ferris LA , Holt SK , Ramos JD , Harshman LC , Plimack ER , Crabb SJ , Pal SK , De Giorgi U , Ladoire S , Baniel J , Necchi A , Vaishampayan UN , Bamias A , Bellmunt J , Srinivas S , Dorff TB , Galsky MD , Yu EY
Treatment of Metastatic Urothelial Carcinoma After Previous Cisplatin-based Chemotherapy for Localized Disease: A Retrospective Comparison of Different Chemotherapy Regimens
Clin Genitourin Cancer. 2021 Apr;19(2) :125-134
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The optimal chemotherapy regimen for metastatic urothelial carcinoma following previous cisplatin-based chemotherapy, administered for localized disease, remains unclear. We found benefit of platinum-based over non-platinum-based first-line chemotherapy for patients with metastatic disease treated at least 1 year from completion of prior perioperative and/or peri-radiation cisplatin-based chemotherapy. These findings support return to platinum chemotherapy in this clinical scenario. Background: Optimal chemotherapy for patients who received cisplatin for localized urothelial carcinoma (UC) and develop metastatic disease is unclear. We compared the efficacy of platinum-based (PBC) versus non-platinumbased (NPBC) first-line chemotherapy for metastasis. Patients and Methods: Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3024 patients from 28 international academic centers from 2005 to 2012. Patient inclusion criteria included: (1) predominant UC; (2) any primary tumor site; (3) cT2-4, cN0-N2, cM0; (4) prior receipt of perioperative/radiation cisplatin-containing chemotherapy; and (5) receipt of cytotoxic chemotherapy in the first-line metastatic setting. Multivariate Cox proportional hazards models were used to show progression-free survival (PFS) and overall survival (OS) from the first day of chemotherapy for metastatic disease to date of censor. Results: Eligibility criteria was met by 132 patients (n = 74 PBC; n = 58 NPBC). The median OS was 8.13 months (interquartile range, 4.87-16.64 months) and 8.77 months (interquartile range, 4.01-13.49 months) for PBC and NPBC, respectively. Neither OS (hazard ratio [HR], 1.04; 95% confidence & nbsp;interval [CI], 0.64-1.69; P = .87) nor PFS (HR, 0.86; 95% CI, 0.56-1.31; P = .48) differed for PBC versus NPBC. However, for patients who received chemotherapy more than a year after perioperative/radiation chemotherapy, OS was superior for PBC over NPBC (HR, 0.31; 95% CI, 0.10-0.92; P = .03). Conclusions: There is no significant outcome difference between PBC and NPBC in patients with metastatic UC who previously received cisplatin-based chemotherapy for localized disease. However, if over a year has elapsed, return to PBC is associated with superior OS. Clinical Genitourinary Cancer, Vol. 19, No. 2, 125-34 & ordf; 2020 Elsevier Inc. All rights reserved.
Do, Olivia A. Ferris, Lorin A. Holt, Sarah K. Ramos, Jorge D. Harshman, Lauren C. Plimack, Elizabeth R. Crabb, Simon J. Pal, Sumanta K. Giorgi, Ugo De Ladoire, Sylvain Baniel, Jack Necchi, Andrea Vaishampayan, Ulka N. Bamias, Aristotelis Bellmunt, Joaquim Srinivas, Sandy Dorff, Tanya B. Galsky, Matt D. Yu, Evan Y. Crabb, Simon/0000-0003-3521-9064; Do, Olivia A./0000-0003-3483-7522 1938-0682