Olivia A Do1, Lorin A Ferris1, Sarah K Holt2, Jorge D Ramos3, Lauren C Harshman4, Elizabeth R Plimack5, Simon J Crabb6, Sumanta K Pal7, Ugo De Giorgi8, Sylvain Ladoire9, Jack Baniel10, Andrea Necchi11, Ulka N Vaishampayan12, Aristotelis Bamias13, Joaquim Bellmunt14, Sandy Srinivas15, Tanya B Dorff7, Matt D Galsky16, Evan Y Yu17. 1. School of Medicine, University of Washington School of Medicine, Seattle, WA. 2. Department of Urology, University of Washington Medical Center, Seattle, WA. 3. Seagen Inc, Bothell, WA. 4. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. 5. Division of Genitourinary Medical Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA. 6. University of Southampton, Clinical Trials Unit, MP131, Southampton General Hospital, Southampton, Hants, United Kingdom. 7. Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA. 8. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy. 9. Georges Francois Leclerc Cancer Center INSERM U1231, Dijon, France. 10. Department of Urology, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel. 11. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 12. Department of Internal Medicine/Oncology, University of Michigan, Ann Arbor, MI. 13. Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece. 14. Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA. 15. Department of Medicine/Oncology, Stanford Cancer Institute, Palo Alto, CA. 16. Department of Medicine, Division of Oncology, Mount Sinai Hospital, New York, NY. 17. Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA. Electronic address: evanyu@uw.edu.
Abstract
BACKGROUND: Optimal chemotherapy for patients who received cisplatin for localized urothelial carcinoma (UC) and develop metastatic disease is unclear. We compared the efficacy of platinum-based (PBC) versus non-platinum-based (NPBC) first-line chemotherapy for metastasis. PATIENTS AND METHODS: Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3024 patients from 28 international academic centers from 2005 to 2012. Patient inclusion criteria included: (1) predominant UC; (2) any primary tumor site; (3) cT2-4, cN0-N2, cM0; (4) prior receipt of perioperative/radiation cisplatin-containing chemotherapy; and (5) receipt of cytotoxic chemotherapy in the first-line metastatic setting. Multivariate Cox proportional hazards models were used to show progression-free survival (PFS) and overall survival (OS) from the first day of chemotherapy for metastatic disease to date of censor. RESULTS: Eligibility criteria was met by 132 patients (n = 74 PBC; n = 58 NPBC). The median OS was 8.13 months (interquartile range, 4.87-16.64 months) and 8.77 months (interquartile range, 4.01-13.49 months) for PBC and NPBC, respectively. Neither OS (hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.64-1.69; P = .87) nor PFS (HR, 0.86; 95% CI, 0.56-1.31; P = .48) differed for PBC versus NPBC. However, for patients who received chemotherapy more than a year after perioperative/radiation chemotherapy, OS was superior for PBC over NPBC (HR, 0.31; 95% CI, 0.10-0.92; P = .03). CONCLUSIONS: There is no significant outcome difference between PBC and NPBC in patients with metastatic UC who previously received cisplatin-based chemotherapy for localized disease. However, if over a year has elapsed, return to PBC is associated with superior OS.
BACKGROUND: Optimal chemotherapy for patients who received cisplatin for localized urothelial carcinoma (UC) and develop metastatic disease is unclear. We compared the efficacy of platinum-based (PBC) versus non-platinum-based (NPBC) first-line chemotherapy for metastasis. PATIENTS AND METHODS: Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3024 patients from 28 international academic centers from 2005 to 2012. Patient inclusion criteria included: (1) predominant UC; (2) any primary tumor site; (3) cT2-4, cN0-N2, cM0; (4) prior receipt of perioperative/radiation cisplatin-containing chemotherapy; and (5) receipt of cytotoxic chemotherapy in the first-line metastatic setting. Multivariate Cox proportional hazards models were used to show progression-free survival (PFS) and overall survival (OS) from the first day of chemotherapy for metastatic disease to date of censor. RESULTS: Eligibility criteria was met by 132 patients (n = 74 PBC; n = 58 NPBC). The median OS was 8.13 months (interquartile range, 4.87-16.64 months) and 8.77 months (interquartile range, 4.01-13.49 months) for PBC and NPBC, respectively. Neither OS (hazard ratio [HR], 1.04; 95% confidence interval [CI], 0.64-1.69; P = .87) nor PFS (HR, 0.86; 95% CI, 0.56-1.31; P = .48) differed for PBC versus NPBC. However, for patients who received chemotherapy more than a year after perioperative/radiation chemotherapy, OS was superior for PBC over NPBC (HR, 0.31; 95% CI, 0.10-0.92; P = .03). CONCLUSIONS: There is no significant outcome difference between PBC and NPBC in patients with metastatic UC who previously received cisplatin-based chemotherapy for localized disease. However, if over a year has elapsed, return to PBC is associated with superior OS.
Authors: Risa L Wong; Lorin A Ferris; Olivia A Do; Sarah K Holt; Jorge D Ramos; Simon J Crabb; Cora N Sternberg; Joaquim Bellmunt; Sylvain Ladoire; Ugo De Giorgi; Lauren C Harshman; Ulka N Vaishampayan; Andrea Necchi; Sandy Srinivas; Sumanta K Pal; Guenter Niegisch; Tanya B Dorff; Matthew D Galsky; Evan Y Yu Journal: Oncologist Date: 2021-08-17