Abstract
Patients with urothelial carcinoma (uc) have a poor prognosis after progression on first-line cisplatin-based chemotherapy. Real-world data about second-line cytotoxic therapies are limited. We sought to characterize patients with metastatic uc who receive more than 1 line of systemic therapy and to describe their treatments and outcomes. Using BC Cancer's pharmacy database, we identified patients with documented metastatic uc who had received more than 1 line of systemic therapy. A retrospective chart review was then performed to collect clinicopathologic, treatment, and outcomes data. The 51 included patients, of whom 42 were men (82%), had a median age of 65 years (range: 38-81 years). Sites of metastasis included lymph nodes (n = 30), bone (n = 7), lung (n = 9), and peritoneum (n = 2). Second-line chemotherapy regimens included gemcitabine-cisplatin [gc (n = 14)], paclitaxel (n = 24), docetaxel (n = 12), and an oral topoisomerase i inhibitor (n = 1). Median time to progression (ttp) and overall survival (os) were 2.0 and 6.83 months respectively. Compared with patients who received a different agent, patients who had experienced a prior response to first-line gc and who were re-challenged with second-line gc had a better median ttp (11.0 months vs. 6.0 months, p = 0.02) and survived longer (4.0 months vs. 1.0 months, p = 0.02). No differences in os between non-gc regimens were evident. In patients with metastatic uc, overall outcomes remain poor, but compared with patients receiving other agents, the subgroup of patients re-challenged with second-line gc demonstrated improved ttp. Conventional chemotherapy regimens provide only modest benefits in the second-line setting and have largely been replaced with immunotherapy.
Highlights
Patients with urothelial carcinoma have a poor prognosis after progression on first-line cisplatinbased chemotherapy
We undertook a retrospective patient-based institutional analysis to characterize patients with metastatic uc who received more than 1 line of systemic therapy and to describe their second-line treatments and outcomes
The BC Cancer pharmacy database was reviewed for the period 1 January 2007 to 12 October 2015 to identify patients with documented metastatic uc who received more than 1 line of systemic therapy, including docetaxel, paclitaxel, pemetrexed, carboplatin–paclitaxel, and gemcitabine– cisplatin
Summary
Patients with urothelial carcinoma (uc) have a poor prognosis after progression on first-line cisplatinbased chemotherapy. Real-world data about second-line cytotoxic therapies are limited. We sought to characterize patients with metastatic uc who receive more than 1 line of systemic therapy and to describe their treatments and outcomes. Cisplatin-based chemotherapy is still considered the standard first-line treatment in the metastatic setting, with a median survival of 13–15 months[2,3,4,5]. Phase iii trials of second-line systemic therapies have included vinflunine and gemcitabine–paclitaxel, prognosis remains poor[6,7,8]. Real-world data about the relative efficacy of second-line cytotoxic chemotherapy are limited. We undertook a retrospective patient-based institutional analysis to characterize patients with metastatic uc who received more than 1 line of systemic therapy and to describe their second-line treatments and outcomes
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