Outcome of elderly patients following platinum-based chemotherapy for advanced urothelial cancer

Abstract

4542 Background: Elderly patients represent a significant proportion of patients with advanced urothelial tract cancer in Europe and USA. Nevertheless, there is limited information regarding the tolerability of and benefit from systemic chemotherapy in this population. We, therefore, analysed the tolerability and efficacy of platinum-based chemotherapy in patients of 70 years of age or older who had been entered into our database. Methods: 381 consecutive patients with advanced urothelial cancer were included in this analysis. All patients had been treated with cisplatin or carboplatin-based chemotherapy within the context of 4 studies. 116 patients were > 70 years and were analysed separately. Results: Elderly patients had lower baseline median creatinine clearance (52.4 vs. 68.7 ml/min, p<0.001), lower baseline hemoglobin (11.96 vs. 12.46 g/dl, p=0.017) and received carboplatin-based chemotherapy more frequently (32.8% vs. 11.7%, p<0.001) than younger patients. Median number of chemotherapy cycles, relative dose intensity and overall response rates were similar between the two groups. Grade 3 or 4 toxicity was also similar except from anemia, which was more frequent among elderly patients (13.7% vs. 4.7%, p=0.037). Median follow up of living was 34.8 months. Median survival for elderly patients was 9.3 months and for younger patients 10.8 months (p=0.16).Univariate analysis of baseline characteristics of elderly patients showed that ECOG PS 2 or 3, hemoglobin 10000, weight loss and liver metastases were associated with worse prognosis. Multivariate analysis showed that PS and baseline Hb were independently associated with prognosis (p=0.001 and p=0.017, respectively). Patients with PS 0 or 1 and hemoglobin >= 10 g/dl (n=71) had a median survival of 13.9 months, while patients with one or two adverse prognostic features (n=42) had a median survival of 5 months (p<0.0001). Conclusions: Elderly patients tolerate platinum-based chemotherapy as well as younger patients and benefit to the same extent. The combination of PS and baseline hemoglobin can be useful in accurately defining two groups of patients with distinctly different outcome. No significant financial relationships to disclose.