Impact of Prior Platinum-Based Therapy on Patients Receiving Salvage Systemic Treatment for Advanced Urothelial Carcinoma.
Trials of salvage therapy for advanced urothelial carcinoma have required prior platinum-based therapy. This practice requires scrutiny because non-platinum-based first-line therapy may be offered to cisplatin-ineligible patients.



Data of patients receiving salvage systemic chemotherapy were collected. Data on prior first-line platinum exposure were required in addition to treatment-free interval, hemoglobin, Eastern Cooperative Oncology Group performance status, albumin, and liver metastasis status. Cox proportional hazard regression was used to evaluate their association with overall survival (OS) after accounting for salvage single-agent or combination chemotherapy.



Data were obtained from 455 patients previously exposed to platinum-based therapy and 37 not exposed to platinum. In the group exposed to prior platinum therapy, salvage therapy consisted of a single-agent taxane (n = 184) or a taxane-containing combination chemotherapy (n = 271). In the group not exposed to prior platinum therapy, salvage therapy consisted of taxane or vinflunine (n = 20), 5-fluorouracil (n = 1), taxane-containing combination chemotherapy (n = 12), carboplatin-based combinations (n = 2), and cisplatin-based combinations (n = 2). The median OS for the prior platinum therapy group was 7.8 months (95% confidence interval, 7.0, 8.1), and for the group that had not received prior platinum therapy was 9.0 months (95% confidence interval, 6.0, 11.0; P = .50). In the multivariable analysis, prior platinum therapy versus no prior platinum exposure did not confer an independent impact on OS (hazard ratio, 1.10; 95% confidence interval, 0.75, 1.64; P = .62).



Prior platinum- versus non-platinum-based chemotherapy did not have a prognostic impact on OS after accounting for major prognostic factors in patients receiving salvage systemic chemotherapy for advanced urothelial carcinoma. Lack of prior platinum therapy should not disqualify patients from inclusion onto trials of salvage therapy.
UAB Comprehensive Cancer Center, Birmingham, AL. Electronic address: gsonpavde@uabmc.edu.
G
G
Sonpavde
McMaster University, Hamilton, Ontario, Canada.
G R
GR
Pond
University Federico II, Naples, Italy.
G
G
Di Lorenzo
Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy.
C
C
Buonerba
Istituto Neurotraumatologico Italiano, Grottaferrata, Italy.
A
A
Rozzi
Istituto Neurotraumatologico Italiano, Grottaferrata, Italy.
G
G
Lanzetta
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
A
A
Necchi
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
P
P
Giannatempo
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
D
D
Raggi
Kitasato University School of Medicine, Sagamihara, Japan.
K
K
Matsumoto
Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
T K
TK
Choueiri
Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
S
S
Mullane
Heinrich Heine University, Medical Faculty, Dusseldorf, Germany.
G
G
Niegisch
Heinrich Heine University, Medical Faculty, Dusseldorf, Germany.
P
P
Albers
Asan Medical Center, Seoul, South Korea.
J L
JL
Lee
Sapporo Medical University School of Medicine, Sapporo, Japan.
H
H
Kitamura
University of Tokyo Hospital, Tokyo, Japan.
H
H
Kume
Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
J
J
Bellmunt
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D011379:Prognosis; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D043823:Taxoids / Q000627:therapeutic use*; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy*
D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D009944:Organoplatinum Compounds; D043823:Taxoids; C080625:taxane
Chemotherapy; Overall survival; Prior platinum therapy; Salvage; Urothelial carcinoma