OBJECTIVE: To investigate the potential benefit of intermittent chemotherapy, and to identify the eligibility criteria offering intermittent chemotherapy to patients with advanced urothelial cancer. MATERIALS AND METHODS: Twenty patients who responded or had stable disease after receiving 3 cycles of induction chemotherapy (gemcitabine and cisplatin, or paclitaxel and carboplatin) were enrolled for a prospective study of intermittent chemotherapy. We evaluated for the duration of chemotherapy holiday, toxicity, quality of life (QOL), and overall survival. RESULTS: The median number of cycles was 7 (range, 3-25). On resumption of treatment after the first chemotherapy holiday, 65% of the patients had partial response, 25% had stable disease, and 10% of the patients developed disease progression. The median duration of chemotherapy holiday was 22 weeks (range, 4-94), and the median chemotherapy holiday rate (CHR) was 0.53 (range, 0.25-0.86). The duration of the first chemotherapy holiday of more than 8 weeks significantly correlated to a high CHR. A response to induction chemotherapy, and normal levels of albumin and hemoglobin significantly correlated with a higher CHR. A significant improvement in fatigue, nausea and vomiting, and appetite loss was seen in the symptom scales of QLQ-C30 during the chemotherapy holiday. CONCLUSIONS: Intermittent chemotherapy is a feasible treatment strategy to balance disease control and QOL in selected patients.
OBJECTIVE: To investigate the potential benefit of intermittent chemotherapy, and to identify the eligibility criteria offering intermittent chemotherapy to patients with advanced urothelial cancer. MATERIALS AND METHODS: Twenty patients who responded or had stable disease after receiving 3 cycles of induction chemotherapy (gemcitabine and cisplatin, or paclitaxel and carboplatin) were enrolled for a prospective study of intermittent chemotherapy. We evaluated for the duration of chemotherapy holiday, toxicity, quality of life (QOL), and overall survival. RESULTS: The median number of cycles was 7 (range, 3-25). On resumption of treatment after the first chemotherapy holiday, 65% of the patients had partial response, 25% had stable disease, and 10% of the patients developed disease progression. The median duration of chemotherapy holiday was 22 weeks (range, 4-94), and the median chemotherapy holiday rate (CHR) was 0.53 (range, 0.25-0.86). The duration of the first chemotherapy holiday of more than 8 weeks significantly correlated to a high CHR. A response to induction chemotherapy, and normal levels of albumin and hemoglobin significantly correlated with a higher CHR. A significant improvement in fatigue, nausea and vomiting, and appetite loss was seen in the symptom scales of QLQ-C30 during the chemotherapy holiday. CONCLUSIONS: Intermittent chemotherapy is a feasible treatment strategy to balance disease control and QOL in selected patients.