Cisplatin-based chemotherapy is the treatment of choice in metastatic urothelial cancer (mUC). Nevertheless, about 50% of patients do not receive this treatment. Recently, specific criteria for unfitness-for-cisplatin (UFC) have been published. We used a multinational database to study the impact of adherence to UFC criteria in the outcome of unselected mUC patients
Selection criteria: diagnosis of mUC, transitional, mixed, squamous and adeno histologies, survival data available. Major end point: Overall survival (OS). UFC was defined according to Galsky et al (2011).
From 1828 mUC patients 441 (24%) did not receive any chemotherapy. These patients had a significantly shorter median OS (Table). 1361 patients (median fup: 31 months) were included in the analysis of the following treatment types: cisplatin-based (689;50%), carboplatin-based (404;30%), no cis- or carbo-platin [other (268;20%)]. Cisplatin therapy was associated with longer OS (Table). 971 patients had full data regarding UFC. The following deviations from the UFC criteria were noted: 21% and 32% of the carboplatin and the other groups were fit-for-cisplatin, while 38% of the cisplatin-treated patients fulfilled at least one UFC criterion. UFC patients had inferior outcome. This effect was significant only in cisplatin-treated patients (Table), while the benefit from cisplatin was also more pronounced within the fit-for-cisplatin patients. This cisplatin therapy-UFC interaction was significant (p = 0.0343)