Combination of gemcitabine and carboplatin in urothelial cancer patients unfit for cisplatin due to impaired renal or cardiac function
Int. braz. j. urol
; 38(1): 49-56, Jan.-Feb. 2012. graf, tab
Article
in En
| LILACS
| ID: lil-623314
Responsible library:
BR1.1
ABSTRACT
PURPOSE:
Combination of gemcitabine and carboplatin is the accepted treatment for metastatic urothelial cancer patients unfit for cisplatin-based chemotherapy. MATERIALS ANDMETHODS:
Gemcitabine 1000 mg/m² (days 1, 8) and carboplatin AUC-4.5 (day 1) were given every 21 days to 23 patients with creatinine clearance < 60 mL/min, cardiac ejection fraction < 45% or active ischemia. Patient characteristics included median age 73 (56-86) years; primary site bladder 17 (73%), upper tract 6 (27%) patients; Bajorin's prognostic groups good 6 (26%), intermediate 11 (48%) and poor 6 (26%) patients. Data was retrospectively documented. Patients were followed until they expired.RESULTS:
We obtained objective responses in 8 (34.7%) patients, (95% CI, 16.3-57.2%), including one patient with complete response. The median progression-free survival was 4 (0.2-16.5+) months and the overall survival 8.6 (0.2-45.3+) months. At time of analysis, 4 patients (17%) remained disease free; 3 of them underwent resection of residual disease. Toxicity included infection in 9 (39%) patients; among them, one died from pneumonia; bleeding > grade 2 in 3 (13%) patients and fatigue grade 3 in 2 (9%) patients. Hematologic toxicity included grade 4 thrombocytopenia in 2 (9%) patients and grade 4 neutropenia in 3 (13%) patients. Five (22%) patients discontinued therapy due to toxicity.CONCLUSIONS:
Combination of gemcitabine and carboplatin demonstrated clinical activity in patients with advanced urothelial cancer unfit for cisplatin. It was associated with considerable toxicity. Resection of residual disease is feasible in this population.Key words
Full text:
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Index:
LILACS
Main subject:
Urinary Bladder Neoplasms
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Carcinoma, Transitional Cell
/
Antineoplastic Combined Chemotherapy Protocols
/
Cisplatin
Type of study:
Prognostic_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
En
Journal:
Int. braz. j. urol
Journal subject:
UROLOGIA
Year:
2012
Type:
Article