1704 SEQUENTIAL CHEMOTHERAPY FOR ADVANCED BLADDER CANCER WITH CREATININE CLEARANCE 60 ML/MIN OR BELOW

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease II1 Apr 20101704 SEQUENTIAL CHEMOTHERAPY FOR ADVANCED BLADDER CANCER WITH CREATININE CLEARANCE 60 ML/MIN OR BELOW Takahiro Yoneyama, Kengo Imanishi, Teppei Okamoto, Naoki Sugiyama, Yuuichirou Suzuki, Shingo Hatakeyama, Shigemasa Kudo, Kazuyuki Mori, Yasuhiro Hashimoto, Takuya Koie, Noritaka Kamimura, and Chikara Ohyama Takahiro YoneyamaTakahiro Yoneyama More articles by this author , Kengo ImanishiKengo Imanishi More articles by this author , Teppei OkamotoTeppei Okamoto More articles by this author , Naoki SugiyamaNaoki Sugiyama More articles by this author , Yuuichirou SuzukiYuuichirou Suzuki More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Shigemasa KudoShigemasa Kudo More articles by this author , Kazuyuki MoriKazuyuki Mori More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , Takuya KoieTakuya Koie More articles by this author , Noritaka KamimuraNoritaka Kamimura More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1551AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The standard chemotherapy for advanced bladder cancer is cisplatin-based. However, cisplatin is proved to be too toxic for the patients with impaired renal function. We retrospectively evaluated the feasibility and effectiveness of a sequential chemotherapy for the patients with advanced bladder cancer whose creatinine clearance (Ccr) was 60 ml/min or below. METHODS The subjects were 29 patients with advanced bladder cancer (21 men and 8 women) whose Ccr were 60 ml/min or below. They were treated at our clinic between September 2004 and April 2009. Their average age was 68.9 years old (43-83), average Ccr of 41.8 ml/min (14.5-58.0), and an average follow-up period of 14.0 months (2-55). There were 14 recurrent cases after radical surgery and 15 inoperable cases (T4b or metastatic). As for prior chemotherapy, 6 underwent MVAC therapy. The therapeutic regimen consisted of three lines: gemcitabine/carboplatin (GC) therapy as the first line, with two courses as a set; GC/docetaxel (GCD) therapy as the second line if the response in the first line was insufficient; and finally as the third line, docetaxel/ifosfamide/nedaplatin (DIN) therapy if the GCD therapy was not sufficient. GC consisted of 800mg/m2 gemcitabine on days 1, 8, and 15 and carboplatin (AUC 4) on day 2. If this regimen was effective, another 2 courses of GC was performed. If this regimen did not induce any tumor size reduction, we switched to GCD, which consisted of 800mg/m2 gemcitabine on days 1 and 8, 70mg/m2 docetaxel on day 1, and carboplatin(AUC 3) on day 2. DIN consisted of 75mg/m2 docetaxel on day 1, 2g/m2 ifosfamide on day 1 though day 3, and 100mg/m2 nedaplatin on day 2. RESULTS Of the 29 subjects who had undergone the GC therapy, the response rate was 44.8% (CR+PR) with 4 and 9 subjects exhibiting a complete response (CR) and a partial response (PR), respectively; the average response duration was 8.6 months (3-27). Of the subjects with MVAC resistance, 1 exhibited a CR and 2 showed a PR. The response rates of 7 instances of GCD and 5 instances of DIN were 14.3% and 20.0%, respectively; the overall median survival was 13.0 months throughout the sequential chemotherapy. Adverse events (AE) of grade 3 or higher occurred in 21 of those who had undergone the GC therapy (72.4%). Bone marrow suppression was observed in 21 subjects (72.4%), whereas only 2 (6.9%) developed digestive symptoms. No subjects experienced the deterioration of their renal functions. CONCLUSIONS Although the present study is small and preliminary, the present sequential chemotherapy is safe and active for advanced bladder cancer with impaired renal function. Hirosaki, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e658 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahiro Yoneyama More articles by this author Kengo Imanishi More articles by this author Teppei Okamoto More articles by this author Naoki Sugiyama More articles by this author Yuuichirou Suzuki More articles by this author Shingo Hatakeyama More articles by this author Shigemasa Kudo More articles by this author Kazuyuki Mori More articles by this author Yasuhiro Hashimoto More articles by this author Takuya Koie More articles by this author Noritaka Kamimura More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...