C M Booth1, D R Siemens2, Y Peng3, I F Tannock4, W J Mackillop5. 1. Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston Department of Oncology Department of Public Health Sciences boothc@kgh.kari.net. 2. Department of Oncology Department of Urology, Queen's University, Kingston. 3. Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston Department of Public Health Sciences. 4. Princess Margaret Cancer Centre, Toronto, Canada. 5. Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston Department of Oncology Department of Public Health Sciences.
Abstract
BACKGROUND: Few articles have documented regimens and timing of perioperative chemotherapy for bladder cancer in routine practice. Here, we describe practice patterns in the general population of Ontario, Canada. METHODS: In this retrospective cohort study, treatment and physician billing records were linked to the Ontario Cancer Registry to describe use of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy among all patients with muscle-invasive bladder cancer treated with cystectomy in Ontario 1994-2008. Time to initiation of ACT (TTAC) was measured from cystectomy. Multivariate Cox regression was used to identify factors associated with overall (OS) and cancer-specific survival (CSS). RESULTS: Of 2944 patients undergoing cystectomy, 4% (129/2944) and 19% (571/2944) were treated with NACT and ACT, respectively. Five-year OS was 25% [95% confidence interval (CI) 17% to 34%] for NACT, 29% (95% CI 25% to 33%) for ACT cases. Among patients with identifiable drug regimens, cisplatin was used in 82% (253/308) and carboplatin in 14% (43/308). The most common regimens were gemcitabine-cisplatin (54%, 166/308) and methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) (21%, 66/308). Mean TTAC was 10 weeks; 23% of patients had TTAC >12 weeks. TTAC >12 weeks was associated with inferior OS [hazard ratio (HR) 1.28, 95% CI 1.00-1.62] and CSS (HR 1.30, 95% CI 1.00-1.69). In adjusted analyses, OS and CSS were lower among patients treated with carboplatin compared with those treated with cisplatin; OS HR 2.14 (95% CI 1.40-3.29) and CSS HR 2.06 (95% CI 1.26-3.37). CONCLUSIONS: Most patients in the general population receive cisplatin, and this may be associated with superior outcomes to carboplatin. Initiation of ACT beyond 12 weeks is associated with inferior survival. Patients should start ACT as soon as they are medically fit to do so.
BACKGROUND: Few articles have documented regimens and timing of perioperative chemotherapy for bladder cancer in routine practice. Here, we describe practice patterns in the general population of Ontario, Canada. METHODS: In this retrospective cohort study, treatment and physician billing records were linked to the Ontario Cancer Registry to describe use of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy among all patients with muscle-invasive bladder cancer treated with cystectomy in Ontario 1994-2008. Time to initiation of ACT (TTAC) was measured from cystectomy. Multivariate Cox regression was used to identify factors associated with overall (OS) and cancer-specific survival (CSS). RESULTS: Of 2944 patients undergoing cystectomy, 4% (129/2944) and 19% (571/2944) were treated with NACT and ACT, respectively. Five-year OS was 25% [95% confidence interval (CI) 17% to 34%] for NACT, 29% (95% CI 25% to 33%) for ACT cases. Among patients with identifiable drug regimens, cisplatin was used in 82% (253/308) and carboplatin in 14% (43/308). The most common regimens were gemcitabine-cisplatin (54%, 166/308) and methotrexate, vinblastine, doxorubicin, cisplatin (MVAC) (21%, 66/308). Mean TTAC was 10 weeks; 23% of patients had TTAC >12 weeks. TTAC >12 weeks was associated with inferior OS [hazard ratio (HR) 1.28, 95% CI 1.00-1.62] and CSS (HR 1.30, 95% CI 1.00-1.69). In adjusted analyses, OS and CSS were lower among patients treated with carboplatin compared with those treated with cisplatin; OS HR 2.14 (95% CI 1.40-3.29) and CSS HR 2.06 (95% CI 1.26-3.37). CONCLUSIONS: Most patients in the general population receive cisplatin, and this may be associated with superior outcomes to carboplatin. Initiation of ACT beyond 12 weeks is associated with inferior survival. Patients should start ACT as soon as they are medically fit to do so.
Authors: Di Maria Jiang; Shilpa Gupta; Abhijat Kitchlu; Alejandro Meraz-Munoz; Scott A North; Nimira S Alimohamed; Normand Blais; Srikala S Sridhar Journal: Nat Rev Urol Date: 2021-01-11 Impact factor: 14.432
Authors: Matthew D Galsky; Michael Diefenbach; Nihal Mohamed; Charles Baker; Sumit Pokhriya; Jason Rogers; Ashish Atreja; Liangyuan Hu; Che-Kai Tsao; John Sfakianos; Reza Mehrazin; Nikhil Waingankar; William K Oh; Madhu Mazumdar; Bart S Ferket Journal: JCO Clin Cancer Inform Date: 2017-11
Authors: Timothy P Hanna; Will D King; Stephane Thibodeau; Matthew Jalink; Gregory A Paulin; Elizabeth Harvey-Jones; Dylan E O'Sullivan; Christopher M Booth; Richard Sullivan; Ajay Aggarwal Journal: BMJ Date: 2020-11-04