Gemcitabine and Docetaxel As Second-line Chemotherapy in Elderly Patients with Metastatic Urothelial Carcinoma: a Retrospective Analysis

Overview

Journal Cancer Manag Res

Publisher Dove Medical Press

Specialty Oncology

Date 2018 Oct 2

PMID 30271215

Citations 2

Authors

Taku Naiki

Keitaro Iida

Toshiki Etani

Takashi Nagai

Yutaro Tanaka

Yosuke Sugiyama

Ryosuke Ando

Shuzo Hamamoto

Rika Banno

Daisuke Nagata

Noriyasu Kawai

Takahiro Yasui

Affiliations

Soon will be listed here.

Abstract

Background: The 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 Methods: A 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/m gemcitabine and 40 mg/m 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.

Results: The 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.

Conclusion: In 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.

Citing Articles

Cachexia Index Is a Prognostic Indicator in Patients With Metastatic Urothelial Carcinoma Treated With Systemic Chemotherapy.

Mimura Y, Naiki T, Sugiyama Y, Tasaki Y, Odagiri K, Etani T Cancer Diagn Progn. 2024; 4(4):475-481.

PMID: 38962546 PMC: 11215442. DOI: 10.21873/cdp.10351.

Antibiotic therapy augments the efficacy of gemcitabine-containing regimens for advanced cancer: a retrospective study.

Imai H, Saijo K, Komine K, Otsuki Y, Ohuchi K, Sato Y Cancer Manag Res. 2019; 11:7953-7965.

PMID: 31686910 PMC: 6709792. DOI: 10.2147/CMAR.S215697.

References

Powles T, ODonnell P, Massard C, Arkenau H, Friedlander T, Hoimes C . Efficacy and Safety of Durvalumab in Locally Advanced or Metastatic Urothelial Carcinoma: Updated Results From a Phase 1/2 Open-label Study. JAMA Oncol. 2017; 3(9):e172411. PMC: 5824288. DOI: 10.1001/jamaoncol.2017.2411. View

Hurria A, Levit L, Dale W, Mohile S, Muss H, Fehrenbacher L . Improving the Evidence Base for Treating Older Adults With Cancer: American Society of Clinical Oncology Statement. J Clin Oncol. 2015; 33(32):3826-33. DOI: 10.1200/JCO.2015.63.0319. View

Ikeda M, Matsumoto K, Tabata K, Minamida S, Fujita T, Satoh T . Combination of gemcitabine and paclitaxel is a favorable option for patients with advanced or metastatic urothelial carcinoma previously treated with cisplatin-based chemotherapy. Jpn J Clin Oncol. 2011; 41(10):1214-20. DOI: 10.1093/jjco/hyr131. View

Crome P, Lally F, Cherubini A, Oristrell J, Beswick A, Clarfield A . Exclusion of older people from clinical trials: professional views from nine European countries participating in the PREDICT study. Drugs Aging. 2011; 28(8):667-77. DOI: 10.2165/11591990-000000000-00000. View

Salah S, Lee J, Rozzi A, Kitamura H, Matsumoto K, Vis D . Second-line Chemotherapy in Older Patients With Metastatic Urothelial Carcinoma: Pooled Analysis of 10 Second-line Studies. Clin Genitourin Cancer. 2017; 15(4):e563-e571. DOI: 10.1016/j.clgc.2016.12.014. View

Sehl M, Sawhney R, Naeim A . Physiologic aspects of aging: impact on cancer management and decision making, part II. Cancer J. 2006; 11(6):461-73. DOI: 10.1097/00130404-200511000-00005. View

Spiess P, Agarwal N, Bangs R, Boorjian S, Buyyounouski M, Clark P . Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017; 15(10):1240-1267. DOI: 10.6004/jnccn.2017.0156. View

Shariat S, Sfakianos J, Droller M, Karakiewicz P, Meryn S, Bochner B . The effect of age and gender on bladder cancer: a critical review of the literature. BJU Int. 2009; 105(3):300-8. PMC: 4315315. DOI: 10.1111/j.1464-410X.2009.09076.x. View

Naiki T, Iida K, Kawai N, Etani T, Ando R, Nagai T . A pilot study of gemcitabine and paclitaxel as third-line chemotherapy in metastatic urothelial carcinoma. J Rural Med. 2017; 12(2):105-111. PMC: 5721294. DOI: 10.2185/jrm.2940. View

10.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

11.

Powles T, Duran I, van der Heijden M, Loriot Y, Vogelzang N, De Giorgi U . Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2017; 391(10122):748-757. DOI: 10.1016/S0140-6736(17)33297-X. View

12.

Sternberg C, De Mulder P, Schornagel J, Theodore C, Fossa S, Van Oosterom A . Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours. Eur J Cancer. 2005; 42(1):50-4. DOI: 10.1016/j.ejca.2005.08.032. View

13.

Kitamura H, Taguchi K, Kunishima Y, Yanase M, Takahashi A, Shigyo M . Paclitaxel, ifosfamide, and nedaplatin as second-line treatment for patients with metastatic urothelial carcinoma: a phase II study of the SUOC group. Cancer Sci. 2011; 102(6):1171-5. PMC: 11159473. DOI: 10.1111/j.1349-7006.2011.01909.x. View

14.

Yuen A, Zou G, Turrisi A, Sause W, Komaki R, Wagner H . Similar outcome of elderly patients in intergroup trial 0096: Cisplatin, etoposide, and thoracic radiotherapy administered once or twice daily in limited stage small cell lung carcinoma. Cancer. 2000; 89(9):1953-60. DOI: 10.1002/1097-0142(20001101)89:9<1953::aid-cncr11>3.3.co;2-y. View

15.

Demols A, Peeters M, Polus M, Marechal R, Gay F, Monsaert E . Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: a phase II study. Br J Cancer. 2006; 94(4):481-5. PMC: 2361170. DOI: 10.1038/sj.bjc.6602966. View

16.

Jan A, Dolan D, Lombardi K, Gupta S . Tolerability of Gemcitabine Plus Cisplatin for Treatment of Urothelial Cancer in the Elderly Population. Clin Genitourin Cancer. 2015; 14(3):e257-63. DOI: 10.1016/j.clgc.2015.09.003. View

17.

Dreicer R, Manola J, Schneider D, Schwerkoske J, George C, Roth B . Phase II trial of gemcitabine and docetaxel in patients with advanced carcinoma of the urothelium: a trial of the Eastern Cooperative Oncology Group. Cancer. 2003; 97(11):2743-7. DOI: 10.1002/cncr.11413. View

18.

Patel M, Ellerton J, Infante J, Agrawal M, Gordon M, Aljumaily R . Avelumab in metastatic urothelial carcinoma after platinum failure (JAVELIN Solid Tumor): pooled results from two expansion cohorts of an open-label, phase 1 trial. Lancet Oncol. 2017; 19(1):51-64. PMC: 7984727. DOI: 10.1016/S1470-2045(17)30900-2. View

19.

Sharma P, Retz M, Siefker-Radtke A, Baron A, Necchi A, Bedke J . Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2017; 18(3):312-322. DOI: 10.1016/S1470-2045(17)30065-7. View

20.

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View