title: Current status of systemic chemotherapy for octogenarians with advanced urothelial cancer in Japan: a Japanese multi-institutional study (CURE study).
abstract: BACKGROUND
  The standard regimen of systemic chemotherapy for patients with advanced urothelial cancer (UC) changed from methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) to gemcitabine and cisplatin (GC) in 2008 when the use of gemcitabine for UC began to be reimbursed by public health insurance in Japan. We examined its influence on the chemotherapy trend in elderly patients aged ≥80 years.
  
  
  METHODS
  Among 345 patients included in our previous multicenter retrospective cohort study (chemotherapy for urothelial carcinoma: renal function and efficacy study; CURE study), the outcome of 30 patients aged ≥80 years was reviewed before and after 2008 and compared with 315 young patients.
  
  
  RESULTS
  There were only 7 (4.6 %) elderly individuals among all registered patients before 2008, whereas the number increased to 23 (12 %) after 2008. Before 2008, only one elderly patient received MVAC, while GC (whose rate was similar to the rate in young patients) was administered to 13 patients (56.5 %) after 2008. The chemotherapeutic effect and overall survival (OS) rate was not significantly different between young and elderly patients. In the elderly treated with the GC regimen, the renal impairment rate after the first cycle was significantly higher, and the presence of distant metastases and renal impairment were independent prognostic factors in a multivariate analysis.
  
  
  CONCLUSIONS
  Since GC was approved as the standard regimen for first-line chemotherapy in UC, selected elderly patients have been able to safely receive systemic chemotherapy like young patients. The clinical response rate and OS rate were similar to the young, but we need to monitor changes in renal function more closely in the elderly treated with GC.
authors.affiliation: Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan. ym1108@kuhp.kyoto-u.ac.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Ishitsuka
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Miyazaki
authors.affiliation: Department of Urology, Akita University Graduate School of Medicine, Akita, 010-8502, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kageyama
authors.affiliation: Department of Urology, Kagawa University, Faculty of Medicine, Kagawa, 761-0701, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Sugimoto
authors.affiliation: Department of Urology, Tohoku University, Graduate School of Medicine, Miyagi, 980-8575, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Mitsuzuka
authors.affiliation: Department of Urology, Hyogo College of Medicine, Hyogo, 663-8501, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Urology and Andrology, Kansai Medical University, Osaka, 573-1191, Japan.
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Wakeda
authors.affiliation: Department of Urology, Tokai University School of Medicine, Kanagawa, 259-1193, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nomoto
authors.affiliation: Department of Urology, Keio University School of Medicine, Tokyo, 160-8582, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.affiliation: Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.|Tsukuba Clinical Research and Development Organization, University of Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Fujie
authors.affiliation: Tsukuba Clinical Research and Development Organization, University of Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Keino
authors.affiliation: Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D014571:Urologic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D019459:Urothelium / Q000473:pathology; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine
keywords: Elderly; Outcome; Renal function; Systemic chemotherapy; Urothelial cancer