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)
|Median OS (months)||95% CI||p|
|1st-line chemotherapy Yes (n = 1499) No (n = 475)||14.6 5.1||13.4-15.5 4.2-6.2|
A sizable proportion of fit-for-cisplatin patients do not receive cisplatin-based chemotherapy. Use of cisplatin for those patients may have potential to improve outcomes. On the contrary, unfit-for-cisplatin patients have a worse outcome and more efficient therapies should be sought.
Clinical trial identification
Legal entity responsible for the study
Icahn School of Medicine at Mount Sinai, USA
All authors have declared no conflicts of interest.