Gemcitabine plus split-dose cisplatin could be a promising alternative to gemcitabine plus carboplatin for cisplatin-unfit patients with advanced urothelial carcinoma.

Abstract

Cisplatin-based chemotherapies are standard treatment regimens of advanced urothelial cell carcinoma. But a significant proportion of patients are unsuitable for cisplatin due to impaired renal function. Carboplatin-based regimens such as gemcitabine and carboplatin regimen (GCb) were applied due to less nephrotoxicity and side effects in these patients. However, it is known that clinical outcome of carboplatin-based regimens was unsatisfactory compared to cisplatin-based regimens. We compared the nephrotoxicity and response to treatment between GCb and gemcitabine plus split-dose cisplatin regimen (GC-S). GC-S consists of cisplatin 35mg/m(2) given on day 1, 2 and gemcitabine 1000mg/m(2) on day 1, 8 every 3weeks. GCb consists of carboplatin (AUC 4.5) on day 1 and gemcitabine 1000mg/m(2) on day 1, 8 every 3weeks. Patient demographics, serum creatinine and calculated GFR, adverse events, and radiologic response were retrospectively reviewed. Forty-four patients with advanced urothelial carcinoma treated with GCb (n=22) or GC-S (n=22) in our institution. There was no difference at deterioration of serum creatinine or GFR between GCb and GC-S (p=0.442, p=0.345). For patients who had GFR<60mL/min/1.73m(2) subgroup, similar results were produced (p=0.292, p=0.186). In addition, GC-S (68.4%) showed improved response compared to GCb (31.6%) (p=0.023). Both treatments were well tolerated, and there were no unexpected serious adverse events. Based on preserved renal function, favorable response, and tolerability, GC-S could be a promising alternative to GCb for cisplatin-unfit patients with advanced urothelial carcinoma.