Treatment of patients with metastatic urothelial cancer "Unfit" for cisplatin-based chemotherapy Journal Article
| Authors: | Galsky, M. D.; Hahn, N. M.; Rosenberg, J.; Sonpavde, G.; Hutson, T.; Oh, W. K.; Dreicer, R.; Vogelzang, N.; Sternberg, C. N.; Bajorin, D. F.; Bellmunt, J. |
| Article Title: | Treatment of patients with metastatic urothelial cancer "Unfit" for cisplatin-based chemotherapy |
| Abstract: | Purpose: Cisplatin-based combination chemotherapy is considered standard first-line treatment for patients with metastatic urothelial carcinoma. However, a large proportion of patients with metastatic urothelial carcinoma are considered "unfit" for cisplatin. The purpose of this review is to define unfit patients and to identify treatment options for this subgroup of patients. Patients and Methods: In this review, the criteria used to define unfit patients are explored and the results of prospective clinical trials evaluating chemotherapeutic regimens in unfit patients are summarized. Results: Several phase II trials and a single, large phase III trial have explored chemotherapeutic regimens for the treatment of unfit patients with metastatic urothelial carcinoma. Heterogeneous eligibility criteria have been used to define unfit patients in these studies. A uniform definition of unfit is proposed on the basis of the results of a survey of genitourinary medical oncologists. According to this definition, unfit patients would meet at least one of the following criteria: Eastern Cooperative Oncology Group performance status of 2, creatinine clearance less than 60 mL/min, grade ≥ 2 hearing loss, grade ≥ 2 neuropathy, and/or New York Heart Association Class III heart failure. Conclusion: Additional studies to optimize treatment for this important subset of patients are needed. A uniform definition of unfit patients will lead to more uniform clinical trials, enhanced ability to interpret the results of these trials, and a greater likelihood of developing a viable strategy for regulatory approval. © 2011 by American Society of Clinical Oncology. |
| Keywords: | cancer survival; treatment outcome; review; cisplatin; doxorubicin; sunitinib; advanced cancer; cancer combination chemotherapy; drug efficacy; drug safety; side effect; gemcitabine; paclitaxel; cancer patient; comparative study; methotrexate; disease association; carboplatin; metastasis; progression free survival; multiple cycle treatment; nephrotoxicity; lung non small cell cancer; mucosa inflammation; neuropathy; thrombocytopenia; peripheral neuropathy; morbidity; creatinine; creatinine blood level; kidney failure; bladder cancer; risk factor; vinblastine; febrile neutropenia; creatinine urine level; drug fatality; kidney function; adjuvant chemotherapy; mitoxantrone; comorbidity; epirubicin; glomerulus filtration rate; navelbine; oxaliplatin; kidney pelvis; transitional cell carcinoma; hearing loss; creatinine clearance; vinflunine; ototoxicity; solitary kidney; metastatic urothelial carcinoma; randomized controlled trial (topic); phase 2 clinical trial (topic); meta analysis (topic); phase 3 clinical trial (topic); heart ejection fraction |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 29 |
| Issue: | 17 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2011-06-10 |
| Start Page: | 2432 |
| End Page: | 2438 |
| Language: | English |
| DOI: | 10.1200/jco.2011.34.8433 |
| PROVIDER: | scopus |
| PUBMED: | 21555688 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 17 August 2011" - "CODEN: JCOND" - "Source: Scopus" |
