Biweekly carboplatin/gemcitabine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: report of efficacy, quality of life and geriatric assessment.

Abstract

OBJECTIVE:

We evaluated safety and efficacy of first-line gemcitabine/carboplatin in unfit-for-cisplatin patients with advanced urothelial carcinoma and the effect on the quality of life and functional status of elderly patients (aged >70).

METHODS:

Unfit patients had ECOG performance status (PS) > or =2, creatinine clearance <50 ml/min or comorbidities precluding cisplatin administration. Carboplatin at area under the curve of 2.5 and gemcitabine 1,250 mg/m(2) were administered biweekly. Elderly patients were stratified into group 1 (no activities of daily living (ADL) or instrumental ADL dependency and no comorbidities), group 2 (instrumental ADL dependency or 1-2 comorbidities) and group 3 (ADL dependency or > or =2 comorbidities).

RESULTS:

Thirty-four patients were enrolled: 68% had PS 2-3, 69% a creatinine clearance <50 ml/min and 65% had 1 or more comorbidities. There were 3 cases of grade 3 toxicity (9%). Response rate was 24% [95% confidence interval (CI) 11-41]. Median follow-up was 8 months, median progression-free survival 4.4 months (95% CI 1.03-7.75) and median overall survival 9.8 months (95% CI 4.7-14.9). Patients in geriatric assessment groups 1 and 2 had a significantly longer median progression-free survival compared to group 3 [6.9 months (95% CI 1.3-12.4) vs. 1.9 months (95% CI 0.5-3.2); p = 0.005].

CONCLUSION:

First-line gemcitabine/carboplatin combination is active in unfit-for-cisplatin patients with advanced urothelial carcinoma. Pretreatment quality of life and geriatric assessment may be useful in selecting patients likely to benefit from this treatment.

• Authors: Aristotle Bamias, George Lainakis, Efstathios Kastritis, Nikos Antoniou, Gerassimos Alivizatos, Andreas Koureas, Michael Chrisofos, Andreas Skolarikos, Evangelos Karayiotis, Meletios A Dimopoulos
• Journal: Oncology (Oncology) Vol. 73 Issue 5-6 Pg. 290-7 ( 2007) ISSN: 1423-0232 [Electronic] Switzerland
• PMID: 18477854 (Publication Type: Journal Article)
• Copyright: 2008 S. Karger AG, Basel.

Chemical References

• Deoxycytidine
• Creatinine
• Carboplatin
• Cisplatin
• Gemcitabine

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Carboplatin (administration & dosage)
• Carcinoma, Transitional Cell (drug therapy, mortality, pathology)
• Cisplatin (adverse effects)
• Creatinine (metabolism)
• Deoxycytidine (administration & dosage, analogs & derivatives)
• Drug Administration Schedule
• Female
• Humans
• Male
• Middle Aged
• Patient Selection
• Quality of Life
• Survival Analysis
• Treatment Outcome
• Urologic Neoplasms (drug therapy, mortality, pathology)
• Gemcitabine