Clinical significance of a second-line chemotherapy regimen with paclitaxel, ifosfamide and nedaplatin for metastatic urothelial carcinoma after failure of cisplatin-based chemotherapy.
OBJECTIVE
Cisplatin-based chemotherapy has been commonly used as the first-line chemotherapy for metastatic urothelial carcinoma. However, after failure of the first-line cisplatin-based chemotherapy, there is no established standard second-line chemotherapy. Starting in 2006, paclitaxel, ifosfamide and nedaplatin chemotherapy has been performed as the second-line chemotherapy in our institution. Here, we report the treatment results of paclitaxel, ifosfamide and nedaplatin chemotherapy.


METHODS
From 2006 to 2015, 33 patients with metastatic urothelial carcinoma were treated with paclitaxel, ifosfamide and nedaplatin chemotherapy after failure of first-line cisplatin-based chemotherapy in our institution. We retrospectively examined the treatment outcome and predictive factors for therapeutic effects of paclitaxel, ifosfamide and nedaplatin. The median age, treatment cycle and follow-up period were 62.5 years, 3 cycles and 10.4 months, respectively.


RESULTS
The median overall survival and progression-free survival were 10.4 and 3.5 months, respectively. Complete and partial responses were found in 3 and 7 patients, respectively, with an overall response rate of 30%. All patients developed grade 3-4 neutropenia, but there was no treatment-related death. In multivariate analysis, the only prognostic factor for progression-free survival was 24-hour urinary creatinine clearance.


CONCLUSIONS
A paclitaxel, ifosfamide and nedaplatin regimen as second-line chemotherapy for metastatic urothelial carcinoma was effective and tolerable. Moreover, paclitaxel, ifosfamide and nedaplatin chemotherapy may be more effective in patients with satisfactory renal function.
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Keita
K
Kobayashi
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan hidde@yamaguchi-u.ac.jp.
Hideyasu
H
Matsuyama
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Kosuke
K
Shimizu
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Nakanori
N
Fujii
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Ryo
R
Inoue
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Yoshiaki
Y
Yamamoto
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Hiroaki
H
Matsumoto
Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Kazuhiro
K
Nagao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002945:Cisplatin / Q000627:therapeutic use*; D003404:Creatinine / Q000652:urine; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology; D009944:Organoplatinum Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014523:Urethral Neoplasms / Q000188:drug therapy* / Q000401:mortality
D009944:Organoplatinum Compounds; C053989:nedaplatin; D003404:Creatinine; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide
bladder cancer; chemotherapy; metastatic neoplasm; pelvic cancer; ureter cancer