Carboplatin-based combination chemotherapy for elderly patients with advanced bladder cancer.

Abstract

We evaluated retrospectively the feasibility and effectiveness of carboplatin-based combination chemotherapy in elderly patients with advanced bladder cancer. Forty-seven patients with advanced bladder cancer (33 men and 14 women) and treated at our hospital between August 2004 and December 2011 were enrolled. The average age was 77.1 years (range 70-86 years), the average creatinine clearance was 37.0 ml/min (range 14.5-113.0 ml/min), and the average follow-up period was 17.4 months (range 10-55 months). Twenty-nine patients (61.7 %) were unfit for cisplatin-based chemotherapy. There were 15 recurrent cases after radical surgery and 32 inoperable cases. In this study, the first-line therapy was gemcitabine and carboplatin (GCarbo), with two courses as a set. The second-line therapy was GCarbo and docetaxel (GCarboD) if there was an insufficient response to the first-line therapy. Of the 47 patients who underwent GCarbo therapy, the response rate was 38.3 % (complete response plus partial response), with 5 and 13 patients exhibiting a complete response and a partial response, respectively. The average response duration was 15.7 months (range 2-42 months). The response rate of the nine patients who received GCarboD was 11.1 %, and the overall median survival was 15.0 months. Adverse events occurred in 30 patients (63.8 %) who underwent GCarbo therapy. Bone marrow suppression was observed in 30 patients (61.7 %), and digestive symptoms were observed in three patients (9.0 %). Our study demonstrates that GCarbo is a safe and effective combination chemotherapy in elderly patients with advanced bladder cancer. However, the GCarboD regimen appears to have limited effectiveness for nonresponders to GCarbo therapy.