Abstract
Purpose
Cisplatin-based chemotherapies are standard treatment regimens of advanced urothelial cell carcinoma. But a significant proportion of patients are unsuitable for cisplatin due to impaired renal function. Carboplatin-based regimens such as gemcitabine and carboplatin regimen (GCb) were applied due to less nephrotoxicity and side effects in these patients. However, it is known that clinical outcome of carboplatin-based regimens was unsatisfactory compared to cisplatin-based regimens. We compared the nephrotoxicity and response to treatment between GCb and gemcitabine plus split-dose cisplatin regimen (GC-S).
Methods
GC-S consists of cisplatin 35 mg/m2 given on day 1, 2 and gemcitabine 1000 mg/m2 on day 1, 8 every 3 weeks. GCb consists of carboplatin (AUC 4.5) on day 1 and gemcitabine 1000 mg/m2 on day 1, 8 every 3 weeks. Patient demographics, serum creatinine and calculated GFR, adverse events, and radiologic response were retrospectively reviewed.
Results
Forty-four patients with advanced urothelial carcinoma treated with GCb (n = 22) or GC-S (n = 22) in our institution. There was no difference at deterioration of serum creatinine or GFR between GCb and GC-S (p = 0.442, p = 0.345). For patients who had GFR < 60 mL/min/1.73 m2 subgroup, similar results were produced (p = 0.292, p = 0.186). In addition, GC-S (68.4 %) showed improved response compared to GCb (31.6 %) (p = 0.023). Both treatments were well tolerated, and there were no unexpected serious adverse events.
Conclusions
Based on preserved renal function, favorable response, and tolerability, GC-S could be a promising alternative to GCb for cisplatin-unfit patients with advanced urothelial carcinoma.
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Acknowledgments
This study was supported by a Grant (HI12C1788, HI14C1931, HI14C1731) from the Korean Health Technology R&D Project, Ministry of Health and Welfare, Korea.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standard
This study was reviewed and approved by the Institutional Review Board of Asan Medical Center. For this type of study, formal consent is not required.
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Kim, Y.R., Lee, J.L., You, D. et al. Gemcitabine plus split-dose cisplatin could be a promising alternative to gemcitabine plus carboplatin for cisplatin-unfit patients with advanced urothelial carcinoma. Cancer Chemother Pharmacol 76, 141–153 (2015). https://doi.org/10.1007/s00280-015-2774-z
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DOI: https://doi.org/10.1007/s00280-015-2774-z