Platinum-based systemic chemotherapy is considered the backbone for management of advanced urothelial carcinomas. However there is a lack of real world data on the use of such chemotherapy regimens, on patient profiles and on management after treatment failure.
Fifty-one randomly selected physicians from 4 European countries registered 218 consecutive patients in progression or relapse following a first platinum-based chemotherapy. Patient characteristics, tumor history and treatment regimens, as well as the considerations of physicians on the management of urothelial carcinoma were recorded.
A systemic platinum-based regimen had been administered as the initial chemotherapy in 216 patients: 15 in the neoadjuvant setting, 61 in adjuvant therapy conditions, 137 in first-line advanced setting and 3 in other conditions. Of these patients, 76 (35 %) were initially considered as cisplatin-unfit, mainly because of renal impairment (52 patients). After platinum failure, renal impairment was observed in 44 % of patients, ECOG Performance Status ≥ 2 in 17 %, hemoglobinemia < 10 g/dL in 16 %, hepatic metastases in 13 %. 80 % of these patients received further anticancer therapy. Immediately after failure of adjuvant/neoadjuvant chemotherapy, most subsequent anticancer treatments were chemotherapy doublets (35/58), whereas after therapy failure in the advanced setting most patients receiving further anticancer drugs were treated with a single agent (80/114). After first progression to chemotherapy, treatment decisions were mainly driven by Performance Status and prior response to chemotherapy (>30 % patients). The most frequent all-settings second anticancer therapy regimen was vinflunine (70 % of single-agent and 42 % of all subsequent treatments), the main reasons evoked by physicians (>1 out of 4) being survival benefit, safety and phase III evidence.
In this daily practice experience, a majority of patients with urothelial carcinoma previously treated with a platinum-based therapy received a second chemotherapy regimen, most often a single agent after an initial chemotherapy in the advanced setting and preferably a cytotoxic combination after a neoadjuvant or adjuvant chemotherapy. Performance Status and prior response to chemotherapy were the main drivers of further treatment decisions.
BMC cancer. 2016 Sep 23*** epublish ***
N Houédé, G Locker, C Lucas, H Soto Parra, U Basso, D Spaeth, R Tambaro, L Basterretxea, F Morelli, C Theodore, L Lusuardi, N Lainez, A Guillot, G Tonini, J Bielle, X Garcia Del Muro
Institut de Cancérologie du Gard - CHU Caremeau, 30029, Nîmes, Cedex 9, France. ., Department of Internal Medicine I, Währinger Gürtel.18-20, 1090, Vienne, Austria., Institut de Recherche Pierre Fabre, 45 place Abel Gance, 92100, Boulogne-Billancourt, France., Oncologia Medica, P.O Gaspare Rodolico, Via Santa Sofia 78, 95123, Catania, Italy., Istituto Oncologico Veneto IOV-IRCCS Oncologia Medica, 1 Via Gattamelata 64, Padova, Italy., Centre d'Oncologie de Gentilly, 2 rue Marie Marvingt, 54100, Nancy, France., Istituto Nazionale Tumori IRCCS Fondazione Pascale, Via Mariano Semmola, 80131, Napoli, Italy., Hospital Universitario Donostia, Begiristain Doktorea Pasealekua 117-20080, Donostia, Gipuzkoa - San Sebastián, Spain., Fondazione Casa Sollievo della Sofferenza Oncologia, Viale Cappuccini 1, San Giovanni Rotondo, Foggia, Italy., Hopital Foch, 40 rue Worth, 92150, Suresnes, France., Reparto di Urologia - Ospedale di Bressanone, Via Dante 51, 39042, Bressanone, Italy., Hospital de Navarra - Virgen del Camino, Oncología Médica, Calle de Irunlarrea, 4 planta baja, 31008, Pamplona, Spain., Institut de cancérologie de la Loire, 108 bis avenue Albert Raimond, 42271, Saint Priest en Jarez, Cedex, France., Policlinico Universitario Campus Bio-medico Oncologia Medica, Via Alvaro del Portillo 200, 00128, Roma, Italy., ICO L'Hospitalet, Avinguda Granvia, 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.