Safety of gemcitabine combined with platinum-based adjuvant chemotherapy for upper urinary tract urothelial carcinoma

Abstract

Objective To investigate the safety of gemcitabine combined with cisplatin (GC) / carboplatin (GCa) regimen in adjuvant chemotherapy for upper urinary tract urothelial carcinoma. Methods The clinical and follow-up data of 80 patientswho underwent GC or GCa chemotherapy withinfourcycles of upper tract urothelial carcinoma (UTUC) admitted to Beijing Friendship Hospital, Capital Medical University from June 2012 to January 2018 were analyzed retrospectively, including 39 males and 41 females, aged 36 to 81 years, with a median age of 64.0 years. According to the chemotherapy regimen, all patients were divided into GC group (n=54) and GCa group (n=26). The software of SPSS 22.0 was used to calculate the incidence of adverse reactions of chemotherapy. The independent risk factors for serious adverse reactions were analyzed. The incidence of serious adverse reactions and the safety of renal function in patients with renal insufficiency during chemotherapy were explored. Results For adverse reactions to chemotherapy, GC group had 20 patients(37.0%) with severe myelosuppression, 9 patients(16.4%) with non-hematological toxicity, 3 patients (5.6%) with delayed chemotherapy due to serious chemotherapy adverse reactions, and 12 patients (22.2%) withdrawn chemotherapy early due to inability to tolerate chemotherapy toxicity. In GCa group, 12 patients(46.2%) had severe myelosuppression, 5 patients(19.2%) had severe non-hematologic toxicity, 6 patients(23.1%) had delayed chemotherapy due to serious chemotherapy adverse reactions, and 6 patients (23.1%) had withdrawn chemotherapy early due to inability to tolerate chemotherapy toxicity. Pre-chemotherapye GFR<60 ml·(min·1.73 m2)-1(OR=5.074, 95%CI: 1.222-21.068) was an independent risk factor for severe myelosuppression in GC group (P<0.05). There was no significant difference in severe adverse reactions between the two groups (P<0.05). For the renal function decline between the two groups, Cr and eGFR decreased to a certain extent in the two groups during chemotherapy (P<0.05), but there was no significant difference in the extent and degree during chemotherapy (P<0.05). Conclusions Both GC and GCa adjuvant chemotherapy have certain toxicity and side effects. The process of chemotherapy needs to be closely monitored and timely symptomatic treatment if needed. Most patients can eventually endure chemotherapy.For patients with renal insufficiency, under the precondition of strict monitoring and adequate hydration, GC and GCa regimens adjuvant chemotherapy within four cycles may be the same safe level ofchemotherapy. Key words: Cisplatin; Carboplatin; Antineoplastic combined chemotherapy protocols; Upper urinary tract epithelial cancer; Gemcitabine