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Choice of Platinum in First Line Treatment of Advanced Urothelial Carcinoma in the Era of Second-Line Immunotherapy

By: Julia Fiederlein
Posted: Friday, July 23, 2021

Benjamin Miron, MD, of Fox Chase Cancer Center, Philadelphia, and colleagues conducted a study to evaluate whether the differences in efficacy between first-line cisplatin and carboplatin may influence overall survival outcomes in patients with advanced urothelial carcinoma who received second-line immunotherapy. The results of this retrospective, observational cohort study, which were presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 4535), suggested the choice of platinum-based chemotherapy may not provide a distinguishable benefit.

Using patient-level data from the nationwide Flatiron Health electronic health record–derived de-identified database, the investigators focused on patients who received gemcitabine plus cisplatin (n = 381) or carboplatin (n = 399) prior to undergoing immunotherapy with single-agent atezolizumab, avelumab, durvalumab, nivolumab, or pembrolizumab. Follow-up data were provided for a median of 35 months.

Based on the unadjusted (18.0 vs. 16.2 months; P = .06) and adjusted (hazard ratio = 0.83; P = .055) analyses, the median duration of overall survival from the start of first-line therapy was numerically longer in patients treated with cisplatin than in those who were treated with carboplatin. The duration of the time to immunotherapy was longer with cisplatin than with carboplatin (6.5 vs. 5.5 months; P = .008). The survival time during immunotherapy did not seem to be significantly impacted by the choice of chemotherapy regimen (cisplatin: 8.0 months; carboplatin: 8.2 months; P = .36).

“Despite methodologic limitations of these data, a greater focus in discussions with patients on toxicity associated with cisplatin versus carboplatin may be warranted,” the investigators concluded.

Disclosure: For full disclosures of the study authors, visit coi.asco.org.



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