278P - Sequential chemotherapy with Gemcitabine plus Carboplatin, followed by additional Docetaxel for advanced upper-tract urothelial cancer patient with...

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Cytotoxic agents
Urothelial Cancers
Cancer in Special Situations
Presenter Takahiro Yoneyama
Authors T. Yoneyama1, T. Tanaka1, T. Narita1, M. Oikawa1, K. Hagiwara1, T. Yoneyama1, A. Imai1, S. Hatakeyama1, Y. Hashimoto2, T. Koie1, C. Ohyama1
  • 1Urology, Hirosaki University, 0368563 - Hirosaki/JP
  • 2Urology, Hirosaki University, 0368562 - Hirosaki/JP

Abstract

Background

GC therapy may be a promising regimen for advanced upper-tract urothelial cancer as well as for advanced bladder cancer. However, cisplatin is proved to be too toxic for the patients with impaired renal function. We retrospectively evaluated the effectiveness and adverse events (AEs) of a sequential chemotherapy with gemcitabine+carboplatin(GCarbo) followed by GCcarbo+ Docetaxel (GCarboD) for advanced upper-tract UC whose eGFR was 60 ml/min/1.73m2 or below.

Methods

We treated seventy-four patients with advanced upper-tract urothelial cancer (UTUC) at our clinic between August 2004 and December 2015. 55 patients (37 men and 19 women) whose eGFR were 60 ml/min/1.73m2 or below were enrolled. The average age was 71.0 (50–89), and average eGFR was 43.4 (11.6–59.7) ml/minute/1.73m2. Mean observation period was 27.7 (3–100) months. The patients received 2 courses of GCarbo consisted of 800mg/m2 gemcitabine on days 1, 8, and 15 and carboplatin (AUC 4) on day 2. If this regimen was effective, another 2 courses of GCcarbo was performed. If this regimen did not induce any tumor size reduction, we switched to 2 courses of GCarboD (D; 70mg/m2) treatment as second-line treatment.

Results

GCarbo regimen yielded 4 cases (7.3%) of CR, 25 (45.5%) of PR, and the average duration of response of 16.1 (2–98) months. GCarboD treatment was administered in 14 cases, and yielded 2 (14.3%) PR and a duration of response was 39.5(7-72) months. The median survival period was 14.3 months. As for AEs with GCcarbo regimen, there were 18 (45.0%) of G3/4 blood toxicity, whereas only 5 (12.5%) developed digestive symptoms. In GCarboD regimen, there were 14 (92.9%) of blood toxicity and 5 (35.7%) of gastrointestinal AEs.

Conclusions

Although the present study is small and preliminary, the present sequential chemotherapy is safe and active for advanced UTUC with impaired renal function. GCarbo regimen achieved acceptable response rate (52.8%). The median overall survival of 14.3 months is acceptable when eGFR of 43.7 ml/min/1.73m2 for the subjects is took into consideration. However, GCarboD had limited effectiveness for non-responder of GCarbo.

Clinical trial indentification

none