title: Time from prior chemotherapy enhances prognostic risk grouping in the second-line setting of advanced urothelial carcinoma: a retrospective analysis of pooled, prospective phase 2 trials.
abstract: BACKGROUND
  Outcomes for patients in the second-line setting of advanced urothelial carcinoma (UC) are dismal. The recognized prognostic factors in this context are Eastern Cooperative Oncology Group (ECOG) performance status (PS) >0, hemoglobin level (Hb) <10 g/dl, and liver metastasis (LM).
  
  
  OBJECTIVE
  The purpose of this retrospective study of prospective trials was to investigate the prognostic value of time from prior chemotherapy (TFPC) independent of known prognostic factors.
  
  
  METHODS
  Data from patients from seven prospective trials with available baseline TFPC, Hb, PS, and LM values were used for retrospective analysis (n=570). External validation was conducted in a second-line phase 3 trial comparing best supportive care (BSC) versus vinflunine plus BSC (n=352).
  
  
  METHODS
  Cox proportional hazards regression was used to evaluate the association of factors, with overall survival (OS) and progression-free survival (PFS) being the respective primary and secondary outcome measures.
  
  
  CONCLUSIONS
  ECOG-PS >0, LM, Hb <10 g/dl, and shorter TFPC were significant prognostic factors for OS and PFS on multivariable analysis. Patients with zero, one, two, and three to four factors demonstrated median OS of 12.2, 6.7, 5.1, and 3.0 mo, respectively (concordance statistic=0.638). Setting of prior chemotherapy (metastatic disease vs perioperative) and prior platinum agent (cisplatin or carboplatin) were not prognostic factors. External validation demonstrated a significant association of TFPC with PFS on univariable and most multivariable analyses, and with OS on univariable analyses. Limitations of retrospective analyses are applicable.
  
  
  CONCLUSIONS
  Shorter TFPC enhances prognostic classification independent of ECOG-PS >0, Hb <10 g/dl, and LM in the setting of second-line therapy for advanced UC. These data may facilitate drug development and interpretation of trials.
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL, USA.
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.forename: Ronan
authors.initials: R
authors.lastname: Fougeray
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Angela Q
authors.initials: AQ
authors.lastname: Qu
authors.forename: David J
authors.initials: DJ
authors.lastname: Vaughn
authors.forename: Guenter
authors.initials: G
authors.lastname: Niegisch
authors.forename: Peter
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authors.lastname: Albers
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: James
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.forename: Yoo-Joung
authors.initials: YJ
authors.lastname: Ko
authors.forename: Srikala S
authors.initials: SS
authors.lastname: Sridhar
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Galsky
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Petrylak
authors.forename: Ulka N
authors.initials: UN
authors.lastname: Vaishampayan
authors.forename: Awais
authors.initials: A
authors.lastname: Khan
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Vogelzang
authors.forename: Tomasz M
authors.initials: TM
authors.lastname: Beer
authors.forename: Walter M
authors.initials: WM
authors.lastname: Stadler
authors.forename: Peter H
authors.initials: PH
authors.lastname: O'Donnell
authors.forename: Cora N
authors.initials: CN
authors.lastname: Sternberg
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Rosenberg
authors.forename: Joaquim
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authors.lastname: Bellmunt
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality; D017321:Clinical Trials, Phase I as Topic; D004358:Drug Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000401:mortality