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Adherence to cisplatin-based regimens prescription in "fit" patients fulfilling platinum eligibility criteria. Impact on outcomes: a retrospective international study of invasive/advanced cancer of the urothelium (RISC) analysis

2016; Elsevier BV; Volume: 27; Linguagem: Inglês

10.1093/annonc/mdw373.27

1569-8041

Aristotelis Bamias, Kimon Tzannis, Michalis Liontos, Simon J. Crabb, Lauren C. Harshman, Ugo De Giorgi, Joaquim Bellmunt, Y. Wong, Sumanta K. Pal, Sylvain Ladoire, Cora N. Sternberg, Thomas Powles, Elaine Yu, Günter Niegisch, Andrea Necchi, Ulka N. Vaishampayan, N. Agarwal, Jonathan E. Rosenberg, R. Investigators,

Multiple and Secondary Primary Cancers

Cisplatin-based chemotherapy is the treatment of choice in metastatic urothelial cancer (mUC). Nevertheless, about 50% of patients do not receive this treatment. Recently, specific criteria for unfitness-for-cisplatin (UFC) have been published. We used a multinational database to study the impact of adherence to UFC criteria in the outcome of unselected mUC patients Selection criteria: diagnosis of mUC, transitional, mixed, squamous and adeno histologies, survival data available. Major end point: Overall survival (OS). UFC was defined according to Galsky et al (2011). From 1828 mUC patients 441 (24%) did not receive any chemotherapy. These patients had a significantly shorter median OS (Table). 1361 patients (median fup: 31 months) were included in the analysis of the following treatment types: cisplatin-based (689;50%), carboplatin-based (404;30%), no cis- or carbo-platin [other (268;20%)]. Cisplatin therapy was associated with longer OS (Table). 971 patients had full data regarding UFC. The following deviations from the UFC criteria were noted: 21% and 32% of the carboplatin and the other groups were fit-for-cisplatin, while 38% of the cisplatin-treated patients fulfilled at least one UFC criterion. UFC patients had inferior outcome. This effect was significant only in cisplatin-treated patients (Table), while the benefit from cisplatin was also more pronounced within the fit-for-cisplatin patients. This cisplatin therapy-UFC interaction was significant (p = 0.0343)Tabled 1Median OS (months)95% CIp1st-line chemotherapy Yes (n = 1499) No (n = 475)14.6 5.113.4-15.5 4.2-6.2<.001Treatment Group Cisplatin (n = 689) Carboplatin (n = 404) Other (n = 268)16.7 10.5 9.714.8-18.5 9.3-11.7 7.9-11.8<.001Unfit-for-cisplatin Yes (n = 550) No (n = 421)15.8 9.814.1-18.7 8.6-10.8<.001Cisplatin-treated Fit-for-cisplatin (n = 295) Unfit-for-cisplatin (n = 182) Non-cisplatin treated Fit-for-cisplatin (n = 126) Unfit-for-cisplatin (n = 368)19.4 11.9 12.2 8.615.9-22.4 10.8-14.2 9.4-14.1 7.2-9.6<0.001 0.150 Open table in a new tab A sizable proportion of fit-for-cisplatin patients do not receive cisplatin-based chemotherapy. Use of cisplatin for those patients may have potential to improve outcomes. On the contrary, unfit-for-cisplatin patients have a worse outcome and more efficient therapies should be sought.