title: Second-line Chemotherapy in Older Patients With Metastatic Urothelial Carcinoma: Pooled Analysis of 10 Second-line Studies.
abstract: Older patients with metastatic urothelial carcinoma (UC) are under-represented in clinical trials, and data regarding outcomes for second-line therapy is limited.
  
  
  
  Individual data for patients with metastatic UC, aged ≥ 70 years, were pooled from 10 second-line studies. The influence of potential prognostic factors on overall survival (OS) was assessed via univariate and multivariate Cox regression analysis.
  
  
  
  In total, 102 patients were included; the median age was 74.0 years (range, 70-88 years). Second-line chemotherapy was single-agent in 42 (41%) patients and combination regimens in 60 (59%) patients. Median progression-free and OS were 4.3 and 9.7 months, respectively. In multivariate analysis, age > 75 years, Eastern Cooperative Oncology Group performance status ≥ 1, serum hemoglobin < 10 g/dL, and non-lymph node only metastasis predicted inferior OS. Median OS for patients with 0, 1, 2, and ≥ 3 adverse factors was unreached, 15.5, 9.8, and 4.8 months, respectively (P < .001). There was no difference in OS between patients treated with single-agent or combination chemotherapy. Combination regimens were associated with higher occurrences of any ≥ grade 2 toxicity (80% vs. 38%; P < .001), ≥ grade 2 hematologic (78% vs. 12%; P < .001), and ≥ grade 2 gastrointestinal toxicity (36% vs. 7%; P < .001).
  
  
  
  In this pooled analysis of older patients with metastatic UC, combination chemotherapy for second-line treatment was associated with greater toxicity without improvement in OS. Eastern Cooperative Oncology Group performance status ≥1, serum hemoglobin < 10 g/dL, and age > 75 years predicted worse survival, whereas isolated lymph node metastasis predicted a favorable outcome.
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada. Electronic address: samer.salah@uhn.on.ca.
authors.forename: Samer
authors.initials: S
authors.lastname: Salah
authors.affiliation: Department of Oncology and Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Jae-Lyun
authors.initials: JL
authors.lastname: Lee
authors.affiliation: Medical Oncology Unit, Istituto Neurotraumatologico Italiano (INI), Grottaferrata, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rozzi
authors.affiliation: Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Vis
authors.affiliation: Medical Oncology Department, Stanford University Medical Center, Stanford, CA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Srinivas
authors.affiliation: Genitourinary, CNS, and Sarcoma Tumor Unit, Vall d' Hebron University Hospital, Vall d' Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Morales-Barrera
authors.affiliation: Genitourinary, CNS, and Sarcoma Tumor Unit, Vall d' Hebron University Hospital, Vall d' Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Carles
authors.affiliation: Office of Scientific Affairs and Research, King Hussein Cancer Centre, Amman, Jordan.
authors.forename: Dalia
authors.initials: D
authors.lastname: Al-Rimawi
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
authors.forename: Soonil
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, Korea.
authors.forename: Ki Hong
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lewin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D018450:Disease Progression; D004358:Drug Therapy; D005260:Female; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D016019:Survival Analysis; D016896:Treatment Outcome; D014571:Urologic Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Bladder neoplasm; Cancer metastasis; Geriatric oncology; Prognosis; Urological cancers