title: Maintenance monotherapy with Gemcitabine following cisplatin-based primary combination chemotherapy in surgically treated advanced urothelial carcinoma: A matched-pair single institution analysis.
abstract: The role of maintenance therapy with Gemcitabine (GEM) following cisplatin-based combination chemotherapy (CBCC) in patients with surgically treated advanced urothelial carcinoma (UC) remains to be fully elucidated. In the present case control study, a retrospective analysis was performed to evaluate the role of GEM monotherapy following surgical intervention for advanced UC. Between 1999 and 2013, 38 patients were identified with surgically treated advanced UC after having completed CBCC, who were additionally treated quarterly with two consecutive GEM (1,250 mg/m2) infusions as maintenance therapy. This collective was matched by propensity score matching to a control collective (n=38) that received primary CBCC alone, and the overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) rates were determined for the two collectives using Kaplan-Meier estimates and the log-rank test. Regression analysis was performed using the Cox proportional hazards model. The median follow-up time was 37 months (interquartile range: 9-148). Interestingly, patients treated with GEM following primary chemotherapy had a significantly improved outcome with respect to the 5-year OS (46.2 vs. 26.4%, P=0.0314) and 5-year CSS (61.3 vs. 33.4%, P=0.0386) rates. Notably, the 5-year PFS rate did not differ between the two groups (10.3 vs. 16.1%, P=0.134). It is proposed that additional GEM maintenance monotherapy is able to improve survival rates following primary CBCC in surgically treated patients with advanced UC, suggesting a possible treatment option for patients with, e.g., unclear disease status, or those who would require an active maintenance therapy in the future. Prospective studies should further determine the impact of GEM monotherapy with respect to PFS rates in groups comprising larger numbers of patients.
authors.affiliation: Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany.
authors.forename: Charis
authors.initials: C
authors.lastname: Kalogirou
authors.affiliation: Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany.
authors.forename: Andrey
authors.initials: A
authors.lastname: Svistunov
authors.affiliation: Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Krebs
authors.affiliation: Department of Urology, University of Regensburg, D-93053 Regensburg, Germany.
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Lausenmeyer
authors.affiliation: Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vergho
authors.affiliation: Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany.
authors.forename: Hubertus
authors.initials: H
authors.lastname: Riedmiller
authors.affiliation: Department of Urology and Paediatric Urology, Julius Maximilians University Medical Center of Würzburg, D-97080 Würzburg, Germany.
authors.forename: Arkadius
authors.initials: A
authors.lastname: Kocot
keywords: Gemcitabine; bladder cancer; monotherapy; urothelial carcinoma