The impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients (pts) with transitional cell carcinoma (TCC) of the bladder

Abstract

4586 Background: Neoadjuvant cisplatin-based combination chemotherapy improves survival in pts with (muscle-invasive) TCC of the bladder. While the data supporting adjuvant chemotherapy are somewhat less compelling, most consider post-operative chemotherapy an acceptable alternative. Many pts who may benefit from such therapy are not candidates for cisplatin due to impaired renal function. We sought to identify the proportion of pts ineligible for adjuvant chemotherapy based on renal impairment alone. Methods: We retrospectively reviewed all pts who underwent radical cystectomy for TCC at our institution between 1990 and 2004. Pts were excluded if they received neoadjuvant chemotherapy. Pts meeting our definition of ‘eligible’ for adjuvant therapy had ≥ pT3 and/or node positive disease. The nadir creatinine value obtained from weeks 6–12 post-cystectomy was used to calculate creatinine clearance (CrCl) using the Jellife formula. A CrCl of < 60 mL/min was considered inadequate for cisplatin-based chemotherapy. Results: 512 pts met the inclusion criteria for our analysis. Baseline characteristics included median age = 69.1 years (31.1–94.6), median serum creatinine = 0.9 mg/dL (0.2–2.8), and median CrCl = 65.8 mL/min (18–280). Sixty-one percent (312/512) had ≥ pT3N0/Nx disease and 39% had pTanyN+ disease. Based on a CrCl of < 60, 39.8% (204/512) of pts would be ineligible for adjuvant chemotherapy. The impact of age on eligibility is presented in the Table. Conclusions: Using calculated CrCl and a commonly used cut-off of 60 mL/min for cisplatin-based chemotherapy, up to 40% of patients with TCC who may benefit from adjuvant chemotherapy may be excluded on the basis of renal function alone. Clinical trials addressing this patient population are needed. No significant financial relationships to disclose.