title: Combined chemotherapy with gemcitabine and carboplatin for metastatic urothelial carcinomas in patients with high renal insufficiency.
abstract: BACKGROUND
  This was a retrospective study to evaluate the activity and toxicity of a combined chemotherapeutic regimen of gemcitabine and carboplatin (GCa) in patients with metastatic urothelial carcinomas (UCs) with special regard to patients with highly impaired renal function.
  
  
  METHODS
  Eleven patients whose creatinine clearance was 30 ml/min or under and who had been diagnosed with metastatic UC were treated with GCa. The patient cohort comprised 4 males and 7 females, with a median age of 74 (range 67-84) years. The median follow-up was 19 (range 1-58) months.
  
  
  RESULTS
  Five of the 11 patients (45%) showed an objective response, with 2 achieving a clinically complete response and 3 a partial response with GCa. The grade 3/4 toxicity of the regimen was primarily hematological, including anemia (55%), neutropenia (45%), and thrombocytopenia (45%). Four patients (36%) could not complete the treatment in total. Grade 3 pneumonitis was found in one patient, and the treatment was terminated. Grade 4 febrile neutropenia occurred in the patient on hemodialysis, and the patient was forced to discontinue the chemotherapy. Another 2 patients also called off the treatment due to a pulmonary adverse event and an elevation of serum creatinine, respectively.
  
  
  CONCLUSIONS
  GCa appears to be effective for the treatment of metastatic UCs in patients with impaired renal function, but it is necessary to pay attention to the occurrence of severe adverse events.
authors.affiliation: Department of Urology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan, tanji@m.ehime-u.ac.jp.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Tanji
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Miura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yanagihara
authors.forename: Akitomi
authors.initials: A
authors.lastname: Shirato
authors.forename: Koji
authors.initials: K
authors.lastname: Azuma
authors.forename: Yuki
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Kikugawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimamoto
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Yokoyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D064420:Drug-Related Side Effects and Adverse Reactions / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000473:pathology; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019459:Urothelium / Q000187:drug effects / Q000473:pathology; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine