Aristotle Bamias1, Stavros Peroukidis2, Sophia Stamatopoulou3, Kimon Tzannis1, Konstantinos Koutsoukos4, Charalambos Andreadis5, Vasiliki Bozionelou6, Nikos Pistalmatzian7, Athanasios Papatsoris8, Konstantinos Stravodimos9, Ioannis Varthalitis10, Michalis Karamouzis11, Georgia Milaki12, Antonios Agorastos5, Nikos Kentepozidis13, Nikos Androulakis12, Iliada Bompolaki10, Haralampos Kalofonos2, Dimitrios Mavroudis6, Meletios A Dimopoulos1. 1. Department of Clinical Therapeutics, University of Athens, Athens, Greece. 2. Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece. 3. 1st Department of Medical Oncology, "Agios Savvas" Hospital, Athens, Greece. 4. Department of Clinical Therapeutics, University of Athens, Athens, Greece. Electronic address: koutsoukos.k@gmail.com. 5. 3rd Department of Clinical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece. 6. Department of Medical Oncology, University Hospital of Heraklion, and Medical School, University of Crete, Heraklion, Crete, Greece. 7. "Mitera" Hospital, Athens, Greece. 8. 2nd Department of Urology, Sismanoglio Hospital, School of Medicine, University of Athens, Athens, Greece. 9. Department of Urology, Athens University Medical School, Laiko Hospital, Athens, Greece. 10. Department of Medical Oncology, General Hospital of Chania, Chania, Greece. 11. "Lefkos Stavros" Hospital, Athens, Greece. 12. Department of Medical Oncology, Venizelio Hospital, Heraklion, Greece. 13. Medical Oncology Department, 251 General Air Force Hospital, Athens, Greece.
Abstract
BACKGROUND: Advanced urothelial cancer (AUCa) is associated with poor long-term survival. Two major concerns are related to nonexposure to cisplatin-based chemotherapy and poor outcome after relapse. Our purpose was to record patterns of practice in AUCa in Greece, focusing on first-line treatment and management of relapsed disease. METHODS: Patients with AUCa treated from 2011 to 2013 were included in the analysis. Fitness for cisplatin was assessed by recently established criteria. RESULTS: Of 327 patients treated with first-line chemotherapy, 179 (55%) did not receive cisplatin. Criteria for unfitness for cisplatin were: Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, 21%; creatinine clearance ≤ 60 mL/min, 55%; hearing impairment, 8%; neuropathy, 1%; and cardiac failure, 5%. Forty-six patients (27%) did not fulfill any criterion for unfitness for cisplatin. The main reasons for these deviations were comorbidities (28%) and advanced age (32%). Seventy-four (68%) of 109 patients who experienced a relapse received second-line chemotherapy. The most frequent reason for not offering second-line chemotherapy was poor PS or limited life expectancy (66%). CONCLUSION: In line with international data, approximately 50% of Greek patients with AUCa do not receive cisplatin-based chemotherapy, although 27% of them were suitable for such treatment. In addition, about one third of patients with relapse did not receive second-line chemotherapy because of poor PS or short life expectancy. Enforcing criteria for fitness for cisplatin and earlier diagnosis of relapse represent 2 targets for improvement in current treatment practice for AUCa.
BACKGROUND:Advanced urothelial cancer (AUCa) is associated with poor long-term survival. Two major concerns are related to nonexposure to cisplatin-based chemotherapy and poor outcome after relapse. Our purpose was to record patterns of practice in AUCa in Greece, focusing on first-line treatment and management of relapsed disease. METHODS:Patients with AUCa treated from 2011 to 2013 were included in the analysis. Fitness for cisplatin was assessed by recently established criteria. RESULTS: Of 327 patients treated with first-line chemotherapy, 179 (55%) did not receive cisplatin. Criteria for unfitness for cisplatin were: Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, 21%; creatinine clearance ≤ 60 mL/min, 55%; hearing impairment, 8%; neuropathy, 1%; and cardiac failure, 5%. Forty-six patients (27%) did not fulfill any criterion for unfitness for cisplatin. The main reasons for these deviations were comorbidities (28%) and advanced age (32%). Seventy-four (68%) of 109 patients who experienced a relapse received second-line chemotherapy. The most frequent reason for not offering second-line chemotherapy was poor PS or limited life expectancy (66%). CONCLUSION: In line with international data, approximately 50% of Greek patients with AUCa do not receive cisplatin-based chemotherapy, although 27% of them were suitable for such treatment. In addition, about one third of patients with relapse did not receive second-line chemotherapy because of poor PS or short life expectancy. Enforcing criteria for fitness for cisplatin and earlier diagnosis of relapse represent 2 targets for improvement in current treatment practice for AUCa.
Authors: Aristotelis Bamias; Kimon Tzannis; Christina Bamia; Lauren C Harshman; Simon Crabb; Elizabeth R Plimack; Sumanta Pal; Ugo De Giorgi; Sylvain Ladoire; Christine Theodore; Neeraj Agarwal; Evan Y Yu; Guenter Niegisch; Cora N Sternberg; Sandy Srinivas; Ulka Vaishampayan; Andrea Necchi; Michalis Liontos; Jonathan E Rosenberg; Thomas Powles; Joaquim Bellmunt; Matthew D Galsky Journal: Oncologist Date: 2019-04-01
Authors: A Bamias; K Tzannis; L C Harshman; S J Crabb; Y-N Wong; S Kumar Pal; U De Giorgi; S Ladoire; N Agarwal; E Y Yu; G Niegisch; A Necchi; C N Sternberg; S Srinivas; A Alva; U Vaishampayan; L Cerbone; M Liontos; J Rosenberg; T Powles; J Bellmunt; M D Galsky Journal: Ann Oncol Date: 2018-02-01 Impact factor: 51.769