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Subsequent Chemotherapy for Metastatic Urothelial Carcinoma: Is Platinum-Based Therapy of Benefit?

By: Vanessa A. Carter, BS
Posted: Wednesday, October 20, 2021

Evan Y. Yu, MD, of Fred Hutchinson Cancer Research Center, Seattle, and colleagues compared clinical outcomes with subsequent platinum-based chemotherapy versus non-platinum–based chemotherapy in patients with metastatic urothelial carcinoma. These results, published in The Oncologist, demonstrated improved survival and disease response in patients who received platinum-based chemotherapy compared with individuals given non-platinum–based chemotherapy after having first received platinum-based combination chemotherapy in the first-line setting. However, the findings were not statistically significant.

The investigators focused on the data of 296 patients with metastatic urothelial carcinoma from the Retrospective International Study of Cancers of the Urothelium who experienced disease progression after previous chemotherapy. Participants were administered either subsequent platinum-based chemotherapy (n = 135) or non-platinum–based chemotherapy (n = 161).

The most common non-platinum–based agents were taxanes (71.4%), followed by gemcitabine (11.8%) and pemetrexed (5.0%). For patients on platinum-based agents, 97% of individuals were administered a doublet or combination chemotherapy. Notably, most patients (80.6%) who were previously administered cisplatin received a different combination therapy than their first-line regimen; 58.3% of patients originally treated with carboplatin received a different subsequent chemotherapy.

Although the findings were not statistically significant, individuals who received platinum-based chemotherapy experienced a better median overall survival than those who were administered non-platinum–based regimens (7.9 vs. 5.5 months). Progression-free survival also appeared to be improved in these individuals, but again, it was not statistically significant (4.1 vs. 2.6 months).

More patients given subsequent platinum-based therapy achieved disease control (57.4%) than those on non-platinum–based regimens (44.8%). Stable disease, partial response, and complete response were achieved by 33, 29, and 8 patients on platinum-based chemotherapy, respectively; 37, 21, and 7 patients on non-platinum–based chemotherapy achieved the same results. Of note, there was a higher likelihood of disease progression in patients who had liver metastases and received subsequent platinum-based chemotherapy (hazard ratio = 1.78).

Disclosure: For full disclosures of the study authors, visit theoncologist.onlinelibrary.wiley.com.



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