title: Salvage treatment with low-dose weekly paclitaxel in elderly or poor performance status patients with metastatic urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate the efficacy of weekly, low-dose paclitaxel chemotherapy after the failure of platinum-based combination chemotherapy in elderly or poor performance status patients with metastatic urothelial carcinoma.
  
  
  METHODS
  We retrospectively reviewed the medical records of 25 patients. The regimen consisted of paclitaxel, 60 mg/m2 on days 1, 8 and 15, with or without carboplatin (AUC 2). Treatment was repeated every 4 weeks until disease progression.
  
  
  RESULTS
  Of 25 patients, the median age was 68 years (range, 47-82), 4 (16%) were female, and 15 (60%) had an ECOG performance status of 2. All patients were ≥65 years or had a performance status of 2 in the cases aged <65 years. Six patients received paclitaxel in combination with carboplatin. The overall response rate was 24% (95% CI, 7.3-40.7) with 6 partial responses. Eight patients (32%) achieved stable disease and 5 (20%) had progressive disease. The median time to progression was 4.0 months (95% CI, 2.9-5.1), and median overall survival was 5.5 months (95% CI, 3.7-7.3). Grade 3-4 toxicities were as follows: neutropenia in 9 patients (36%), anemia in 11 (44%), thrombocytopenia in 2 (8%), neutropenic fever in 2 (8%), asthenia in 4 (16%), anorexia in 2 (8%), nausea in 2 (8%), and peripheral neuropathy in 1 (4%). ECOG performance status (0-1 vs 2) was a significant prognostic factor in multivariate analysis.
  
  
  CONCLUSIONS
  Low-dose weekly paclitaxel seems to be a meaningful salvage treatment with moderate activity and acceptable toxicity in elderly or poor performance status patients with metastatic urothelial carcinoma. Oncologists should carefully consider the opportunity of chemotherapy versus best supportive care in these patients.
authors.forename: Jae Joon
authors.initials: JJ
authors.lastname: Han
authors.forename: Yu Jung
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyun
authors.initials: H
authors.lastname: Chang
authors.forename: Jeong-Ok
authors.initials: JO
authors.lastname: Lee
authors.forename: Keun-Wook
authors.initials: KW
authors.lastname: Lee
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.forename: Soo-Mee
authors.initials: SM
authors.lastname: Bang
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000556:secondary; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D056910:Republic of Korea; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019459:Urothelium
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D016190:Carboplatin; D017239:Paclitaxel