Matthew D Galsky1, Susan Krege2, Chia-Chi Lin3, Noah Hahn4, Thorsten H Ecke5, Erin Moshier6, Guru Sonpavde7, James Godbold6, William K Oh6, Aristotle Bamias8. 1. The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY. Electronic address: matthew.galsky@mssm.edu. 2. Urologische Klinik, Alexianer Krefeld GmbH, Krefeld, Germany. 3. Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. 4. Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN. 5. HELIOS Hospital, Bad Saarow, Germany. 6. The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY. 7. US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX; Texas Oncology, Webster, TX. 8. University of Athens & Hellenic Cooperative Oncology Group, Athens, Greece.
Abstract
PURPOSE: Cisplatin-based chemotherapy is standard first-line treatment for metastatic urothelial carcinoma. However, cisplatin is frequently avoided in elderly patients due to concerns regarding toxicities. We analyzed the efficacy, and tolerability, of cisplatin-based chemotherapy in elderly patients. METHODS: Individual patient data were pooled from 8 phase II and III trials evaluating cisplatin-based first-line chemotherapy in patients with metastatic urothelial carcinoma. Adverse events, treatment delivery, response proportions, and survival outcomes were compared between patients aged<70 vs. ≥ 70 years. RESULTS: Of the 543 patients included, 162 patients (30%) were ≥ 70 years old. The majority (93%) of elderly patients were aged 70 to 79 years. There was no significant difference in the proportions of patients experiencing Grade 3 to 4 renal failure, febrile neutropenia, or treatment-related death between younger and older patient cohorts. The median survival of the patients ≥ 70 years was 12.1 months compared to 12.8 months for patients<70 years (P = 0.91). There was no significant difference in survival between age groups when controlling for baseline performance status or the presence of visceral metastases or both. CONCLUSIONS: Fit septuagenarians, with adequate renal function, tolerate cisplatin-based chemotherapy similarly to their younger counterparts and achieve comparable clinical outcomes.
PURPOSE:Cisplatin-based chemotherapy is standard first-line treatment for metastatic urothelial carcinoma. However, cisplatin is frequently avoided in elderly patients due to concerns regarding toxicities. We analyzed the efficacy, and tolerability, of cisplatin-based chemotherapy in elderly patients. METHODS: Individual patient data were pooled from 8 phase II and III trials evaluating cisplatin-based first-line chemotherapy in patients with metastatic urothelial carcinoma. Adverse events, treatment delivery, response proportions, and survival outcomes were compared between patients aged<70 vs. ≥ 70 years. RESULTS: Of the 543 patients included, 162 patients (30%) were ≥ 70 years old. The majority (93%) of elderly patients were aged 70 to 79 years. There was no significant difference in the proportions of patients experiencing Grade 3 to 4 renal failure, febrile neutropenia, or treatment-related death between younger and older patient cohorts. The median survival of the patients ≥ 70 years was 12.1 months compared to 12.8 months for patients<70 years (P = 0.91). There was no significant difference in survival between age groups when controlling for baseline performance status or the presence of visceral metastases or both. CONCLUSIONS: Fit septuagenarians, with adequate renal function, tolerate cisplatin-based chemotherapy similarly to their younger counterparts and achieve comparable clinical outcomes.
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