867P - Outcomes with cisplatin-based first-line therapy for advanced urothelial carcinoma (UC) following previous perioperative cisplatin-based therapy

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Urothelial Cancers
Presenter Guru Sonpavde
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors G. Sonpavde1, A. Necchi2, P. Giannatempo3, G. Di Lorenzo4, B.J. Eigl5, J. Locke5, S. Pal6, N. Agarwal7, A. Poole7, U.N. Vaishampayan8, G. Niegisch9, S. Hussain10, P. Singh11, J. Bellmunt12, G.R. Pond13
  • 1Medical Oncology, University of Alabama at Birmingham Hospital, 35294-3280 - Birmingham/US
  • 2Medical Oncology/urology Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 3Dept. Genitourinary, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 4Genitourinary Cancer Section And Rare-cancer Center, University Federico II, 80131 - Napoli/IT
  • 5Oncology, British Columbia Cancer Agency, V5Z 4E6 - Vancouver/CA
  • 6Medical Oncology And Experimental Therapuetics, City of Hope Cancer Center, 91010 - Duarte/US
  • 7Huntsman Cancer Institute, University of Utah, Salt Lake City/US
  • 8Karmanos Cancer Center, Wayne State University, Detroit/US
  • 9Urologic Oncology, 6Heinrich Heine University, Dusseldorf/DE
  • 10Molecular And Clinical Cancer Medicine, University of Liverpool, Liverpool/GB
  • 11Oncology, University of Arizona, Tucson/US
  • 12Medical Oncology, Bladder Cancer Center, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston/US
  • 13Biostatistics, Ontario Clinical Oncology Group and McMaster University, Hamilton/CA

Abstract

Aim

Outcomes with cisplatin-based first-line therapy for advanced UC following previous perioperative cisplatin-based chemotherapy are unclear. We conducted a retrospective study to evaluate outcomes and identify a threshold of time from prior cisplatin-based perioperative chemotherapy (TFPC) when repeating cisplatin-based chemotherapy may not be justified.

Methods

Data were collected for patients who received cisplatin-based first-line therapy for advanced UC following previous perioperative cisplatin-based therapy. The Kaplan-Meier method was used to estimate survival. Cox proportional hazards models were used to investigate the prognostic ability of variables on overall survival (OS). The multivariable model included patients with complete data for the all factors (visceral metastasis, ECOG performance status [PS], TFPC, anemia, leukocytosis, albumin). All tests and confidence intervals were two-sided and at p = 0.05 level of significance.

Results

Individual level data for 40 patients from 8 institutions were obtained. The study included 33 men (77.5%), the median age was 61 years (range 41 to 71), the majority received gemcitabine plus cisplatin (N = 25, 62.5%) and the median number of cycles was 4 (range 1-8). The median OS was 70 weeks (95% CI: 48.0-81.0). Multivariable Cox regression analysis results showed an independent prognostic impact on OS for PS >0 vs. 0 (HR 4.34 [1.52-12.36], p = 0.006) and TFPC ≥1.5 years vs. <1.5 years (HR 0.44 [0.20-0.99], p = 0.046). Other cutoffs for TFPC (1 or 2 years) did not attain statistical significance, but these analyses may have been limited by small sample size. Patients with TFPC <1 year demonstrated the poorest median survival of ∼9 months.

Conclusions

Longer TFPC ≥1.5 years and ECOG-PS = 0 were independently prognostic for better survival with cisplatin-based first-line chemotherapy for advanced UC following prior perioperative cisplatin-based chemotherapy. The present analysis supports employing >1 year from prior perioperative cisplatin-based chemotherapy to re-challenge with cisplatin-based first-line chemotherapy for metastatic disease.

Disclosure

All authors have declared no conflicts of interest.