Optimal Number of Cycles of First-line Platinum-based Chemotherapy for Metastatic Urothelial Carcinoma.

BACKGROUND/AIM: In recent years, switch maintenance after platinum-based chemotherapy has been a standard of care. However, the appropriate number of systemic chemotherapy cycles against advanced-stage urothelial carcinoma (UC) remains unclear. This study assessed the survival outcomes of first-line platinum-based chemotherapy according to treatment cycles in patients with metastatic disease. PATIENTS AND METHODS: We retrospectively evaluated patients with metastatic bladder and upper urinary tract cancer who received platinum-based combination therapy. Overall survival (OS) was evaluated using the Kaplan-Meier method and the log-rank test. RESULTS: Of 179 patients, 47 (26.3%) were women, and 73 (40.8%) had upper urinary tract cancer. Furthermore, 47 (26.3%) who were not eligible for cisplatin received carboplatin. The median number of treatment cycles was 3 (range=1-14 cycles). The rates of progressive disease within two cycles, from two to four cycles, and from four to six cycles were 18.4%, 19.2%, and 30.6%, respectively. The median OS of patients with 2, 3, 4, 5-6, and ≥7 treatment cycles were 8.6, 14.3, 21.3, 24.4, and 26.1 months, respectively. The OS did not significantly differ between patients receiving four treatment cycles and those receiving ≥5 treatment cycles. In patients with disease control (complete or partial response or stable disease) receiving ≥4 treatment cycles, there was no significant difference in terms of OS between patients receiving four cycles and those receiving six cycles. CONCLUSION: Four cycles of first-line platinum-based chemotherapy can be effective in patients with metastatic UC.

Efficacy and Tolerability of Enfortumab Vedotin for Metastatic Urothelial Carcinoma: Early Experience in the Real World.

BACKGROUND/AIM: This study retrospectively investigated the impact of enfortumab vedotin (EV) monotherapy on the oncological outcome, safety profile, and health-related quality of life (HRQoL) in patients with metastatic urothelial carcinoma. PATIENTS AND METHODS: We assessed 26 consecutive patients who had received EV monotherapy after failure of platinum-based chemotherapy and immune checkpoint blockade therapy at our single institution from December 2021 to January 2023. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), incidence of adverse events (AEs), and EORTC QLQ-C30 as an HRQoL instrument were evaluated. RESULTS: The ORR and DCR were 57.7% and 80.8%, respectively. EV was effective regardless of the patient and tumor characteristics, including the efficacy of previous systemic therapy, performance status, number of Bellmunt risk factors, and presence of variant histology. With a median follow-up time of 7.5 months, the median durations of PFS and OS were 5.4 months and 10.3 months, respectively. Grade ≥3 AEs included neutropenia (15.4%), fatigue (7.7%), appetite loss (7.7%), rash (3.8%), febrile neutropenia (3.8%), hyperglycemia (3.8%), and interstitial pneumonia (3.8%). AEs resulting in withdrawal of EV, interruption of EV, and dose reduction occurred in two (7.7%), nine (34.6%), and 13 patients (50.0%), respectively. The EORTC QLQ-C30 scores from baseline to post-EV introduction remained stable. CONCLUSION: EV monotherapy demonstrated promising anti-tumor activity and tolerability in patients with metastatic urothelial carcinoma.

[IMPACT OF ADJUVANT CHEMOTHERAPY AFTER RADICAL CYSTECTOMY FOR PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER].

(Objective) The study aimed to retrospectively evaluate the therapeutic effects of adjuvant chemotherapy (AC) in patients following radical cystectomy (RC) in locally advanced bladder cancer. (Methods) A single-center-derived database registered 227 patients diagnosed with muscle-invasive bladder cancer and treated with RC and pelvic lymphadenectomy between March 2003 and December 2021. Of these, patients diagnosed with non-organ-confined diseases were classified as either pT3-T4 or pN-positive without distant metastasis. Platinum-based AC was administered for the following categories: two courses for patients with pT3-T4 and pN-negative and three courses for those with pTany and pN-positive. The primary endpoint was the disease-free survival (DFS) and overall survival (OS) between the patients receiving and not receiving AC. (Results) Among all patients, 90 were diagnosed with non-organ-confined disease: 43 (47.8%) were treated with AC and the remaining 47 (52.2%) were left untreated. The methotrexate, vinblastine, doxorubicin, and cisplatin regimen; the gemcitabine and cisplatin regimen; and the gemcitabine and carboplatin regimen were administered to 14 (32.6%), 25 (58.1%), and 4 (9.3%) patients, respectively. With a median follow-up period of 26 months, the groups that received and did not receive AC had 2-year DFS rates of 36.3% and 25.9% (median DFS time: 15 vs. 8 months, p=0.026) and 2-year OS rates of 64.3% and 41.4% (median OS time: 38 vs. 18 months, p=0.064), respectively. In patients with pT3-T4 and pN-negative, no significant difference in the median DFS and OS between the AC and non-AC groups was observed. However, in patients with pTany and pN-positive, the DFS (median: 14 vs. 4.5 months, p=0.002) and OS (38 vs. 11.5 months, p=0.009) were longer in the AC than those in the non-AC group, respectively. The multivariate Cox regression analysis revealed that AC administration was an independent predictor for DFS (hazard ratio: 0.44, 95% confidence interval: 0.24-0.79, p=0.006). (Conclusion) Platinum-based AC following RC significantly improved DFS in pN-positive patients with locally advanced bladder cancer.