Impact of the Number of Cycles of Platinum Based First Line Chemotherapy for Advanced Urothelial Carcinoma

Guru P Sonpavde, Luigi Mariani, Salvatore Lo Vullo, Daniele Raggi, Patrizia Giannatempo, Aristotle Bamias, Simon J Crabb, Joaquim Bellmunt, Evan Y Yu, Guenter Niegisch, Ulka N Vaishampayan, Christine Theodore, Dominik R Berthold, Sandy Srinivas, Srikala S Sridhar, Elizabeth R Plimack, Jonathan E Rosenberg, Thomas Powles, Matthew D Galsky, Andrea Necchi

Research output: Contribution to journalArticle

Abstract

PURPOSE: We evaluated the impact of the number of cycles of platinum based, first line chemotherapy (fewer than 6 cycles vs the conventional 6 cycles or more) on the survival of patients with metastatic urothelial carcinoma.

MATERIALS AND METHODS: We used the RISC (Retrospective International Study of Invasive/Advanced Cancer of the Urothelium) database. The association of the number of cycles of chemotherapy with overall survival was investigated by Cox multiple regression analysis after controlling for recognized prognostic factors. We excluded patients who received fewer than 3 or more than 9 platinum chemotherapy cycles to reduce confounding factors. The primary analysis was a comparison of overall survival for 3 to 5 vs 6 to 9 cycles using 6-month landmark analysis when 281 death events were observed.

RESULTS: Of the 1,020 patients in the RISC 472 received cisplatin or carboplatin, of whom 338 and 134, respectively, were evaluable. A total of 157 patients received 3 to 5 cycles (median 4) and 315 received 6 to 9 cycles (median 6). There was no significant difference in overall survival between 3 to 5 and 6 to 9 cycles (HR 1.02, 95% CI 0.78-1.33, p = 0.91). No significant interactions were observed for the type of platinum (p = 0.09) and completed planned chemotherapy (p = 0.56). The limitations of a hypothesis generating, retrospective analysis applied.

CONCLUSIONS: Four cycles of platinum based, first line chemotherapy appeared adequate and did not significantly compromise the survival of patients with advanced urothelial carcinoma. The omission of excessive cycles may avoid unnecessary cumulative toxicity and facilitate a better transition to second line therapy and investigational switch maintenance therapy strategies. These results require prospective validation but they may impact practice in select patients.

Original languageEnglish
Pages (from-to)1207-1214
Number of pages8
JournalThe Journal of urology
Volume200
Issue number6
DOIs
Publication statusPublished - Dec 2018

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Platinum
Carcinoma
Drug Therapy
Survival
Urothelium
Investigational Therapies
Carboplatin
Cisplatin
Retrospective Studies
Regression Analysis
Databases
Neoplasms

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Impact of the Number of Cycles of Platinum Based First Line Chemotherapy for Advanced Urothelial Carcinoma. / Sonpavde, Guru P; Mariani, Luigi; Lo Vullo, Salvatore; Raggi, Daniele; Giannatempo, Patrizia; Bamias, Aristotle; Crabb, Simon J; Bellmunt, Joaquim; Yu, Evan Y; Niegisch, Guenter; Vaishampayan, Ulka N; Theodore, Christine; Berthold, Dominik R; Srinivas, Sandy; Sridhar, Srikala S; Plimack, Elizabeth R; Rosenberg, Jonathan E; Powles, Thomas; Galsky, Matthew D; Necchi, Andrea.

In: The Journal of urology, Vol. 200, No. 6, 12.2018, p. 1207-1214.

Research output: Contribution to journalArticle

Sonpavde, GP, Mariani, L, Lo Vullo, S, Raggi, D, Giannatempo, P, Bamias, A, Crabb, SJ, Bellmunt, J, Yu, EY, Niegisch, G, Vaishampayan, UN, Theodore, C, Berthold, DR, Srinivas, S, Sridhar, SS, Plimack, ER, Rosenberg, JE, Powles, T, Galsky, MD & Necchi, A 2018, 'Impact of the Number of Cycles of Platinum Based First Line Chemotherapy for Advanced Urothelial Carcinoma', The Journal of urology, vol. 200, no. 6, pp. 1207-1214. https://doi.org/10.1016/j.juro.2018.07.035
Sonpavde, Guru P ; Mariani, Luigi ; Lo Vullo, Salvatore ; Raggi, Daniele ; Giannatempo, Patrizia ; Bamias, Aristotle ; Crabb, Simon J ; Bellmunt, Joaquim ; Yu, Evan Y ; Niegisch, Guenter ; Vaishampayan, Ulka N ; Theodore, Christine ; Berthold, Dominik R ; Srinivas, Sandy ; Sridhar, Srikala S ; Plimack, Elizabeth R ; Rosenberg, Jonathan E ; Powles, Thomas ; Galsky, Matthew D ; Necchi, Andrea. / Impact of the Number of Cycles of Platinum Based First Line Chemotherapy for Advanced Urothelial Carcinoma. In: The Journal of urology. 2018 ; Vol. 200, No. 6. pp. 1207-1214.
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abstract = "PURPOSE: We evaluated the impact of the number of cycles of platinum based, first line chemotherapy (fewer than 6 cycles vs the conventional 6 cycles or more) on the survival of patients with metastatic urothelial carcinoma.MATERIALS AND METHODS: We used the RISC (Retrospective International Study of Invasive/Advanced Cancer of the Urothelium) database. The association of the number of cycles of chemotherapy with overall survival was investigated by Cox multiple regression analysis after controlling for recognized prognostic factors. We excluded patients who received fewer than 3 or more than 9 platinum chemotherapy cycles to reduce confounding factors. The primary analysis was a comparison of overall survival for 3 to 5 vs 6 to 9 cycles using 6-month landmark analysis when 281 death events were observed.RESULTS: Of the 1,020 patients in the RISC 472 received cisplatin or carboplatin, of whom 338 and 134, respectively, were evaluable. A total of 157 patients received 3 to 5 cycles (median 4) and 315 received 6 to 9 cycles (median 6). There was no significant difference in overall survival between 3 to 5 and 6 to 9 cycles (HR 1.02, 95{\%} CI 0.78-1.33, p = 0.91). No significant interactions were observed for the type of platinum (p = 0.09) and completed planned chemotherapy (p = 0.56). The limitations of a hypothesis generating, retrospective analysis applied.CONCLUSIONS: Four cycles of platinum based, first line chemotherapy appeared adequate and did not significantly compromise the survival of patients with advanced urothelial carcinoma. The omission of excessive cycles may avoid unnecessary cumulative toxicity and facilitate a better transition to second line therapy and investigational switch maintenance therapy strategies. These results require prospective validation but they may impact practice in select patients.",
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TY - JOUR

T1 - Impact of the Number of Cycles of Platinum Based First Line Chemotherapy for Advanced Urothelial Carcinoma

AU - Sonpavde, Guru P

AU - Mariani, Luigi

AU - Lo Vullo, Salvatore

AU - Raggi, Daniele

AU - Giannatempo, Patrizia

AU - Bamias, Aristotle

AU - Crabb, Simon J

AU - Bellmunt, Joaquim

AU - Yu, Evan Y

AU - Niegisch, Guenter

AU - Vaishampayan, Ulka N

AU - Theodore, Christine

AU - Berthold, Dominik R

AU - Srinivas, Sandy

AU - Sridhar, Srikala S

AU - Plimack, Elizabeth R

AU - Rosenberg, Jonathan E

AU - Powles, Thomas

AU - Galsky, Matthew D

AU - Necchi, Andrea

N1 - Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2018/12

Y1 - 2018/12

N2 - PURPOSE: We evaluated the impact of the number of cycles of platinum based, first line chemotherapy (fewer than 6 cycles vs the conventional 6 cycles or more) on the survival of patients with metastatic urothelial carcinoma.MATERIALS AND METHODS: We used the RISC (Retrospective International Study of Invasive/Advanced Cancer of the Urothelium) database. The association of the number of cycles of chemotherapy with overall survival was investigated by Cox multiple regression analysis after controlling for recognized prognostic factors. We excluded patients who received fewer than 3 or more than 9 platinum chemotherapy cycles to reduce confounding factors. The primary analysis was a comparison of overall survival for 3 to 5 vs 6 to 9 cycles using 6-month landmark analysis when 281 death events were observed.RESULTS: Of the 1,020 patients in the RISC 472 received cisplatin or carboplatin, of whom 338 and 134, respectively, were evaluable. A total of 157 patients received 3 to 5 cycles (median 4) and 315 received 6 to 9 cycles (median 6). There was no significant difference in overall survival between 3 to 5 and 6 to 9 cycles (HR 1.02, 95% CI 0.78-1.33, p = 0.91). No significant interactions were observed for the type of platinum (p = 0.09) and completed planned chemotherapy (p = 0.56). The limitations of a hypothesis generating, retrospective analysis applied.CONCLUSIONS: Four cycles of platinum based, first line chemotherapy appeared adequate and did not significantly compromise the survival of patients with advanced urothelial carcinoma. The omission of excessive cycles may avoid unnecessary cumulative toxicity and facilitate a better transition to second line therapy and investigational switch maintenance therapy strategies. These results require prospective validation but they may impact practice in select patients.

AB - PURPOSE: We evaluated the impact of the number of cycles of platinum based, first line chemotherapy (fewer than 6 cycles vs the conventional 6 cycles or more) on the survival of patients with metastatic urothelial carcinoma.MATERIALS AND METHODS: We used the RISC (Retrospective International Study of Invasive/Advanced Cancer of the Urothelium) database. The association of the number of cycles of chemotherapy with overall survival was investigated by Cox multiple regression analysis after controlling for recognized prognostic factors. We excluded patients who received fewer than 3 or more than 9 platinum chemotherapy cycles to reduce confounding factors. The primary analysis was a comparison of overall survival for 3 to 5 vs 6 to 9 cycles using 6-month landmark analysis when 281 death events were observed.RESULTS: Of the 1,020 patients in the RISC 472 received cisplatin or carboplatin, of whom 338 and 134, respectively, were evaluable. A total of 157 patients received 3 to 5 cycles (median 4) and 315 received 6 to 9 cycles (median 6). There was no significant difference in overall survival between 3 to 5 and 6 to 9 cycles (HR 1.02, 95% CI 0.78-1.33, p = 0.91). No significant interactions were observed for the type of platinum (p = 0.09) and completed planned chemotherapy (p = 0.56). The limitations of a hypothesis generating, retrospective analysis applied.CONCLUSIONS: Four cycles of platinum based, first line chemotherapy appeared adequate and did not significantly compromise the survival of patients with advanced urothelial carcinoma. The omission of excessive cycles may avoid unnecessary cumulative toxicity and facilitate a better transition to second line therapy and investigational switch maintenance therapy strategies. These results require prospective validation but they may impact practice in select patients.

U2 - 10.1016/j.juro.2018.07.035

DO - 10.1016/j.juro.2018.07.035

M3 - Article

VL - 200

SP - 1207

EP - 1214

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 6

ER -