title: Cisplatin- Versus Non-Cisplatin-based First-Line Chemotherapy for Advanced Urothelial Carcinoma Previously Treated With Perioperative Cisplatin.
abstract: The optimal choice of first-line chemotherapy for patients with relapse of urothelial carcinoma (UC) after perioperative cisplatin-based chemotherapy (PCBC) is unclear. We investigated the outcomes with cisplatin rechallenge versus a non-cisplatin regimen in patients with recurrent metastatic UC after PCBC in a multicenter retrospective study.
  
  
  
  Individual patient-level data were collected for patients who had received various first-line chemotherapy regimens for advanced UC after previous PCBC. Cox proportional hazards models were used to investigate the prognostic ability of the type of perioperative and first-line chemotherapy to independently affect overall survival (OS) and progression-free survival (PFS) after accounting for known prognostic factors.
  
  
  
  Data were available for 145 patients (12 centers). The mean age was 62 years; the Eastern Cooperative Oncology Group (ECOG) performance status (PS) was > 0 for 42.0% of the patients. Of the 145 patients, 63% had received cisplatin-based first-line chemotherapy. The median time from previous chemotherapy (TFPC) was 6.2 months (range, 1-154 months). The median OS was 22 months (95% confidence interval [CI], 18-27 months), and the median PFS was 6 months (95% CI, 5-7 months). A better ECOG PS and a longer TFPC (> 12 months vs. ≤ 12 months; hazard ratio [HR], 0.32; 95% CI, 0.20-0.52; P < .001) was prognostic for OS and PFS. Cisplatin-based chemotherapy was associated with poor OS (HR, 1.86; 95% CI, 1.13-3.06; P = .015), which appeared to be pronounced in those patients with a TFPC of ≤ 12 months. Retreatment with cisplatin in the first-line setting was associated with worse OS (HR, 3.38; P < .001).
  
  
  
  The results of the present retrospective analysis suggest that for patients who have undergone previous PCBC for UC, rechallenging with cisplatin might confer a poorer OS, especially for those with progression within < 1 year.
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Locke
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Gregory Russell
authors.initials: GR
authors.lastname: Pond
authors.affiliation: UAB Comprehensive Cancer Center, Birmingham, AL.
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Necchi
authors.affiliation: Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giannatempo
authors.affiliation: UAB Comprehensive Cancer Center, Birmingham, AL.
authors.forename: Ravi Kumar
authors.initials: RK
authors.lastname: Paluri
authors.affiliation: Heinrich Heine University, Medical Faculty, Dusseldorf, Germany.
authors.forename: Guenter
authors.initials: G
authors.lastname: Niegisch
authors.affiliation: Heinrich Heine University, Medical Faculty, Dusseldorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.affiliation: University Federico II, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Buonerba
authors.affiliation: University Federico II, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
authors.affiliation: Wayne State University Cancer Center, Detroit, MI.
authors.forename: Ulka N
authors.initials: UN
authors.lastname: Vaishampayan
authors.affiliation: Cross Cancer Institute, Edmonton, AB, Canada.
authors.forename: Scott A
authors.initials: SA
authors.lastname: North
authors.affiliation: Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: University of Liverpool, Liverpool, United Kingdom.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Hussain
authors.affiliation: City of Hope Cancer Center, Duarte, CA.
authors.forename: Sumanta
authors.initials: S
authors.lastname: Pal
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada. Electronic address: Bernie.Eigl@bccancer.bc.ca.
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Eigl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage* / Q000627:therapeutic use; D004358:Drug Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000628:therapy*
chemical_list: D002945:Cisplatin
keywords: Cisplatin rechallenge; Eastern Cooperative Oncology Group performance status; Metastatic urothelial carcinoma; Overall survival; Time from previous chemotherapy