Yoshiyuki Matsui1, Osamu Ogawa2, Ryutaro Ishitsuka3, Jun Miyazaki3, Takamitsu Inoue4, Susumu Kageyama5, Mikio Sugimoto6, Koji Mitsuzuka7, Yusuke Shiraishi8, Hidefumi Kinoshita9, Hironobu Wakeda10, Takeshi Nomoto11, Eiji Kikuchi12, Keiko Fujie13,14, Naoto Keino14, Hiroyuki Nishiyama3. 1. Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan. ym1108@kuhp.kyoto-u.ac.jp. 2. Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan. 3. Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. 4. Department of Urology, Akita University Graduate School of Medicine, Akita, 010-8502, Japan. 5. Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan. 6. Department of Urology, Kagawa University, Faculty of Medicine, Kagawa, 761-0701, Japan. 7. Department of Urology, Tohoku University, Graduate School of Medicine, Miyagi, 980-8575, Japan. 8. Department of Urology, Hyogo College of Medicine, Hyogo, 663-8501, Japan. 9. Department of Urology and Andrology, Kansai Medical University, Osaka, 573-1191, Japan. 10. Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan. 11. Department of Urology, Tokai University School of Medicine, Kanagawa, 259-1193, Japan. 12. Department of Urology, Keio University School of Medicine, Tokyo, 160-8582, Japan. 13. Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan. 14. Tsukuba Clinical Research and Development Organization, University of Tsukuba, Ibaraki, 305-8575, Japan.
Abstract
BACKGROUND: The standard regimen of systemic chemotherapy for patients with advanced urothelial cancer (UC) changed from methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) to gemcitabine and cisplatin (GC) in 2008 when the use of gemcitabine for UC began to be reimbursed by public health insurance in Japan. We examined its influence on the chemotherapy trend in elderly patients aged ≥80 years. METHODS: Among 345 patients included in our previous multicenter retrospective cohort study (chemotherapy for urothelial carcinoma: renal function and efficacy study; CURE study), the outcome of 30 patients aged ≥80 years was reviewed before and after 2008 and compared with 315 young patients. RESULTS: There were only 7 (4.6 %) elderly individuals among all registered patients before 2008, whereas the number increased to 23 (12 %) after 2008. Before 2008, only one elderly patient received MVAC, while GC (whose rate was similar to the rate in young patients) was administered to 13 patients (56.5 %) after 2008. The chemotherapeutic effect and overall survival (OS) rate was not significantly different between young and elderly patients. In the elderly treated with the GC regimen, the renal impairment rate after the first cycle was significantly higher, and the presence of distant metastases and renal impairment were independent prognostic factors in a multivariate analysis. CONCLUSION: Since GC was approved as the standard regimen for first-line chemotherapy in UC, selected elderly patients have been able to safely receive systemic chemotherapy like young patients. The clinical response rate and OS rate were similar to the young, but we need to monitor changes in renal function more closely in the elderly treated with GC.
BACKGROUND: The standard regimen of systemic chemotherapy for patients with advanced urothelial cancer (UC) changed from methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) to gemcitabine and cisplatin (GC) in 2008 when the use of gemcitabine for UC began to be reimbursed by public health insurance in Japan. We examined its influence on the chemotherapy trend in elderly patients aged ≥80 years. METHODS: Among 345 patients included in our previous multicenter retrospective cohort study (chemotherapy for urothelial carcinoma: renal function and efficacy study; CURE study), the outcome of 30 patients aged ≥80 years was reviewed before and after 2008 and compared with 315 young patients. RESULTS: There were only 7 (4.6 %) elderly individuals among all registered patients before 2008, whereas the number increased to 23 (12 %) after 2008. Before 2008, only one elderly patient received MVAC, while GC (whose rate was similar to the rate in young patients) was administered to 13 patients (56.5 %) after 2008. The chemotherapeutic effect and overall survival (OS) rate was not significantly different between young and elderly patients. In the elderly treated with the GC regimen, the renal impairment rate after the first cycle was significantly higher, and the presence of distant metastases and renal impairment were independent prognostic factors in a multivariate analysis. CONCLUSION: Since GC was approved as the standard regimen for first-line chemotherapy in UC, selected elderly patients have been able to safely receive systemic chemotherapy like young patients. The clinical response rate and OS rate were similar to the young, but we need to monitor changes in renal function more closely in the elderly treated with GC.
Entities:
Keywords:
Elderly; Outcome; Renal function; Systemic chemotherapy; Urothelial cancer
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