title: Low-dose maintenance gemcitabine-carboplatin chemotherapy could be an alternative to continuous standard chemotherapy for patients with metastatic urothelial carcinoma.
abstract: OBJECTIVE
  To examine whether low-dose maintenance gemcitabine-carboplatin chemotherapy is beneficial for patients with metastatic urothelial carcinoma.
  
  
  METHODS
  We retrospectively reviewed the records of 36 patients with metastatic urothelial carcinoma who received first-line chemotherapy (gemcitabine/cisplatin, gemcitabine/carboplatin, or methotrexate/vinblastine/adriamycin/cisplatin) between 2006 and 2012. Those who had responded, but were unable to tolerate ongoing first-line chemotherapy, had been switched to low-dose maintenance chemotherapy consisting of 1 g/m(2) of gemcitabine and area under the curve 2-4 of carboplatin given on day 1 of a 6-week cycle, and were continued unless disease progression was seen.
  
  
  RESULTS
  After a median of three cycles of first-line chemotherapy, 17 patients had been switched to low-dose maintenance chemotherapy. The median age was 70 years (range 56-79 years), and 12 patients (70.6%) had renal dysfunction (creatinine clearance <60 mL/min). The median number of cycles of low-dose maintenance chemotherapy was six (range 2-22), and the median survival time from initiation of first-line chemotherapy was 12 months (range 4-32 months). Adverse events requiring hospitalization were seen in three patients, but all of them recovered within a few days with conservative treatment. Seven patients discontinued within 9 months, whereas 10 patients continued on low-dose maintenance chemotherapy for ≥9 months. Patients with only lymph node metastases or who had a good response to previous first-line chemotherapy were likely to be able to continue low-dose maintenance chemotherapy.
  
  
  CONCLUSIONS
  Low-dose maintenance gemcitabine-carboplatin chemotherapy might represent an alternative for patients with metastatic urothelial carcinoma not tolerating continuous first-line standard chemotherapy regimens.
authors: Department of Urology, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
authors: Koji
authors: K
authors: Mitsuzuka
authors: Shinichi
authors: S
authors: Yamashita
authors: Shunichi
authors: S
authors: Namiki
authors: Shigeyuki
authors: S
authors: Yamada
authors: Ko
authors: K
authors: Sato
authors: Hideo
authors: H
authors: Saito
authors: Yasuhiro
authors: Y
authors: Kaiho
authors: Akihiro
authors: A
authors: Ito
authors: Haruo
authors: H
authors: Nakagawa
authors: Yoichi
authors: Y
authors: Arai
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols; D016190:Carboplatin / Q000008:administration & dosage* / Q000009:adverse effects; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014571:Urologic Neoplasms / Q000188:drug therapy*; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine
keywords: adverse event; carboplatin; cisplatin-unfit; low-dose maintenance chemotherapy; urothelial carcinoma