title: Cisplatin-based first-line therapy for advanced urothelial carcinoma after previous perioperative cisplatin-based therapy.
abstract: BACKGROUND
  Outcomes with cisplatin-based first-line therapy for advanced UC after previous perioperative cisplatin-based chemotherapy are unclear. In this study we evaluated outcomes with a focus on the effect of time from previous cisplatin-based perioperative chemotherapy.
  
  
  METHODS
  Data were collected for patients who received cisplatin-based first-line therapy for advanced UC after previous perioperative cisplatin-based therapy. Cox proportional hazards models were used to investigate the prognostic ability of visceral metastasis, ECOG PS, TFPC, anemia, leukocytosis, and albumin on overall survival (OS).
  
  
  RESULTS
  Data were available for 41 patients from 8 institutions including 31 men (75.6%). The median age was 61 (range, 41-77) years, most received gemcitabine plus cisplatin (n = 26; 63.4%), and the median number of cycles was 4 (range, 1-8). The median OS was 68 weeks (95% confidence interval [CI], 48.0-81.0). Multivariable Cox regression analysis results showed an independent prognostic effect on OS for PS > 0 versus 0 (hazard ratio [HR], 4.56 [95% CI, 1.66-12.52]; P = .003) and TFPC ≥ 78 weeks versus < 78 weeks (HR, 0.48 [95% CI, 0.21-1.07]; P = .072). The prognostic model for OS was internally validated with c-index = 0.68. Patients with TFPC < 52 weeks, 52 to 104 weeks, and ≥ 104 weeks had median survival of 42, 70, and 162 weeks, respectively.
  
  
  CONCLUSIONS
  Longer TFPC ≥ 78 weeks and ECOG PS = 0 were independently prognostic for better survival with cisplatin-based first-line chemotherapy for advanced UC after previous perioperative cisplatin-based chemotherapy. The data support using TFPC ≥ 52 weeks to rechallenge with cisplatin-based first-line chemotherapy for metastatic disease.
authors.affiliation: Department of Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Department of Statistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.affiliation: Department of Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giannatempo
authors.affiliation: Department of Medicine, University Federico II, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.affiliation: Department of Medicine, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Eigl
authors.affiliation: Department of Medicine, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Jenn
authors.initials: J
authors.lastname: Locke
authors.affiliation: Department of Medicine, City of Hope Cancer Center, Duarte, CA.
authors.forename: Sumanta K
authors.initials: SK
authors.lastname: Pal
authors.affiliation: Department of Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, University of Utah Huntsman Cancer Institute, Salt Lake City, UT.
authors.forename: Austin
authors.initials: A
authors.lastname: Poole
authors.affiliation: Department of Medicine, Wayne State University Cancer Center, Detroit, MI.
authors.forename: Ulka N
authors.initials: UN
authors.lastname: Vaishampayan
authors.affiliation: Department of Urology, Heinrich Heine University, Dusseldorf, Germany.
authors.forename: Guenter
authors.initials: G
authors.lastname: Niegisch
authors.affiliation: Department of Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Hussain
authors.affiliation: Department of Medicine, University of Arizona, Tucson, AZ.
authors.forename: Parminder
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Medicine, Dana Farber Cancer Institute, Boston, MA.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.affiliation: Department of Medicine, UAB Comprehensive Cancer Center, Birmingham, AL. Electronic address: gsonpavde@uabmc.edu.
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002945:Cisplatin / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D019990:Perioperative Care; D016016:Proportional Hazards Models; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D019459:Urothelium / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine
keywords: Cisplatin; First-line; Peri-operative; Urothelial carcinoma