title: Vinflunine treatment in patients with metastatic urothelial cancer: A Nordic retrospective multicenter analysis.
abstract: In 2009, vinflunine was introduced as a second-line treatment to be used after the failure of platinum therapy in patients with metastatic urothelial carcinoma (mUC). The present study investigated the administered vinflunine to patients with mUC in standard clinical practice with the aim of evaluating treatment patterns, response, survival parameters and side-effects. Data were collected retrospectively from the first 100 mUC patients treated with vinflunine at three Nordic cancer centers associated with the Nordic Urothelial Cancer Oncology Group. The overall response rate was 23% and complete response was observed in one patient. The median progression-free survival (mPFS) and median overall survival (mOS) were 2.8 (range, 0.5-34.3) and 6.3 (range, 0.3-39.7) months, respectively. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2 was present in 20% of the patients, and those patients exhibited significantly shorter mOS (4.1 vs. 7.0 months, P=0.001) and a significantly higher degree of grade 3/4 toxicity (P=0.026) compared with ECOG PS 0-1 patients. Furthermore, patients without visceral metastases had significantly longer mOS than patients with visceral metastases (10.6 vs. 6.0 months, P=0.008). The median number of cycles of vinflunine was 3 (range, 1-28). The current data confirms that vinflunine is an active agent for second-line treatment in an unselected clinical cohort of patients with mUC. ECOG PS and presence of visceral metastases were significant prognostic parameters. In particular, patients with ECOG PS 2 receiving vinflunine had a shorter mOS and a higher frequency of severe toxicity, and, thus, should be treated with caution. Furthermore, the present study observed large inter-individual differences in radiological response and OS, indicating the need for further development of improved patient selection tools to optimize vinflunine treatment in platinum-refractory mUC patients.
authors.affiliation: Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Holmsten
authors.affiliation: Department of Oncology, Rigshospitalet, 2100 Copenhagen, Denmark.
authors.forename: Line
authors.initials: L
authors.lastname: Dohn
authors.affiliation: Department of Oncology, Odense University Hospital, 5000 Odense, Denmark.
authors.forename: Niels Viggo
authors.initials: NV
authors.lastname: Jensen
authors.affiliation: Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
authors.forename: Carl-Henrik
authors.initials: CH
authors.lastname: Shah
authors.affiliation: Department of Radiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Jäderling
authors.affiliation: Department of Oncology, Rigshospitalet, 2100 Copenhagen, Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Pappot
authors.affiliation: Department of Oncology and Pathology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ullén
keywords: bladder cancer; platinum-refractory; prognostic factors; vinflunine