Survival Outcomes in Stage IV Bladder Cancer Patients Treated with Cisplatin/Gemcitabine Versus Carboplatin/Gemcitabine: A Retrospective Analysis in Veteran Patients

Anuradha Kunthur,Eric Siegel,Rangaswamy Govindarajan

doi:10.31487/j.cor.2020.06.02

Abstract

Purpose: Gemcitabine/cisplatin (GCi) is the standard regimen used to treat stage IV urothelial bladder cancers. However, most of the bladder cancer patients are older, with poor performance status and renal dysfunction, and are not eligible for cisplatin-containing regimens. There are no randomized studies comparing gemcitabine/carboplatin (GC) and gemcitabine/cisplatin (GCi). Methods: We identified stage IV bladder cancer patients treated within the Veterans Health Administration (VHA), healthcare system between January 2000 and December 2010 from Veterans Affairs Central Cancer Registry (VACCR). Overall survival (OS) was visualized using Kaplan-Meier curves and tested for the significance of the treatment-arm difference using the log-rank test. Results: There were 196 patients with stage IV bladder cancer, out of which 78 patients were treated with GC and 118 patients treated with GCi. The median OS for all patients was 12.5 months a 95% confidence interval (CI) of 10.0-14.6 months. The median OS for patients treated with GC was 13.4 months (95% CI 9.8-17.5 months), and that of the patients treated with GCi was 11.7 months (95% CI 9.3-14.9 months). Cox regression revealed equal group mortality rates, with GC having a (hazard ratio (HR) of 0.96 (CI 0.72-1.27; P= 0.81)) compared to GCi. Conclusion: Our study is the largest comparing GC and GCi in stage IV urothelial bladder cancer patients. It showed that there is no difference in OS in patients treated with GC and GCi.

Highlights

Bladder cancer is the second most common cancer of the genitourinary tract, with approximately 350, 000 new cases worldwide
The median overall survival for patients treated with GC was 13.4 months, and that of patients treated with GCi was 11.7 months
GCi is the preferred first-line regimen used in the treatment of stage IV urothelial bladder cancers [6]

Summary

Introduction

Bladder cancer is the second most common cancer of the genitourinary tract, with approximately 350, 000 new cases worldwide. The American Cancer Society reported 74,000 new cases and 11,000 deaths from bladder cancer as of 2015 [1]. Transitional cell carcinoma (TCC) is the most predominant histological type, and represents more than 90% of Bladder Cancer Survival Outcomes in Stage IV Bladder Cancer Patients Treated with Cisplatin/Gemcitabine chemotherapy [4, 5]. Studies have shown that GC has a better toxicity profile compared to other regimens, and it is the standard regimen used to treat advanced bladder cancer patients, unfit for cisplatin therapy. There is no prospective phase III study comparing GC and GCi in TCC of bladder. We conducted a retrospective cohort study to compare survival outcomes in stage IV TCC of the bladder treated with GC and GCi in veteran population between January 2000 to December 2010

Methods

Results

Conclusion