title: Administration of cisplatin-based chemotherapy for advanced urothelial carcinoma in the community.
abstract: BACKGROUND
  Renal dysfunction, poor performance status, and comorbidities may preclude frontline cisplatin-based chemotherapy in patients with advanced urothelial carcinoma (UC). The frequency of cisplatin-based chemotherapy administration in patients with advanced UC in community-based cancer centers is unknown.
  
  
  METHODS
  A retrospective study was conducted to evaluate chemotherapy regimens administered to patients with the AJCC (American Joint Committee on Cancer) stage-4 UC who, from 2001 to 2010, presented to Texas Oncology Cancer Centers. Frontline chemotherapy was classified as cisplatin based, carboplatin based, nonplatinum based, and as no chemotherapy administered.
  
  
  RESULTS
  A total of 298 patients were eligible for analysis, of whom 197 (66.1%) were men. The median age was 70 years (range, 28-97 years), and the primary sites of disease were bladder (243 [81.5%]), renal pelvis (41 [13.8%]), and ureter (14 [4.7%]). Overall, the regimens administered were cisplatin based in 107 patients (35.9%), carboplatin based in 81 (27.2%), and nonplatinum based in 25 (8.4%); no chemotherapy was administered in 71 (23.8%), and data were not available in 14 patients (4.7%). Cisplatin administration was more common in patients aged ≤70 years (62/150 [41.3%]) as opposed to >70 years (45/148 [30.4%]) (P = .05). Noncisplatin regimens or no chemotherapy were trending to be more commonly administered to patients >70 years (64.2 vs. 54.7%; P = .10). Limitations of a retrospective database study apply.
  
  
  CONCLUSIONS
  A first-line cisplatin-based regimen was administered to 35.9% of patients who presented with AJCC stage 4 UC in a community-based cancer center network. Drug development focused on tolerable single-agent therapy or combination regimens without a cisplatin backbone should be a priority.
authors.affiliation: Texas Oncology, Houston, TX, USA. guru.sonpavde@usoncology.com
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Deidre
authors.initials: D
authors.lastname: Watson
authors.forename: Marcia
authors.initials: M
authors.lastname: Tourtellott
authors.forename: C Lance
authors.initials: CL
authors.lastname: Cowey
authors.forename: Beth
authors.initials: B
authors.lastname: Hellerstedt
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Hutson
authors.forename: Feng
authors.initials: F
authors.lastname: Zhan
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Vogelzang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D016190:Carboplatin; D002945:Cisplatin