The Impact of Cisplatin- or Non-Cisplatin-Containing Chemotherapy on Long-Term and Conditional Survival of Patients with Advanced Urinary Tract Cancer
Year: 2019
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The impact of cisplatin use on long-term survival of unselected patients with advanced urinary tract cancer (aUTC) has not been adequately investigated. We used a multinational database to study long-term survival and the impact of treatment type in unselected patients with aUTC. MATERIALS AND METHODS: A total of 1,333 patients with aUTC (cT4bN0M0, cTanyN+M0, cTanyNanyM+), transitional-cell, squamous, or adenocarcinoma histology who received systemic chemotherapy and had available survival data were selected. Long-term survival was defined as alive at 3 years following initiation of first-line chemotherapy. Conditional overall survival (COS) analysis was employed to study change in prognosis given time survived from initiation of first-line chemotherapy. RESULTS: Median follow-up was 31.7 months. The combination of cisplatin use and cisplatin eligibility accurately predicted long-term survival. Eligible patients treated with cisplatin conferred a 31.6% probability of 3-year survival (95% confidence interval [CI]: 25.1-38.3), and 2-year COS for patients surviving 3 years after initiation of cisplatin-based chemotherapy was 83% (95% CI: 59.7-93.5). The respective probabilities for patients who were ineligible for cisplatin or not treated with cisplatin despite eligibility were 14% (95% CI: 10.8-17.6) and 49.3% (95% CI: 28.2-67.4). Two-year COS remained significantly different between these two groups up to 3 years after chemotherapy initiation. CONCLUSION: Cisplatin-based therapy was associated with the highest likelihood of long-term survival in patients with aUTC and should be used in patients who fulfill the established eligibility criteria. Novel therapies are necessary to increase long-term survival in cisplatin-ineligible patients. IMPLICATIONS FOR PRACTICE: Long-term, disease-free survival is possible in one in four eligible-for-cisplatin patients with advanced urinary tract cancer (aUTC) treated with cisplatin-based combination chemotherapy. Therefore, deviations from eligibility criteria should be avoided. Consolidation surgery should be considered in responders. These data provide benchmarks for the study of novel therapies in aUTC.
Source: The Oncologist
Authors: Aristotelis Bamias, Kimon Tzannis, Christina Bamia, Lauren C. Harshman, Simon Crabb, Elizabeth R. Plimack, Sumanta Pal, Ugo De Giorgi, Sylvain Ladoire, Christine Theodore, Neeraj Agarwal, Evan Y. Yu, Guenter Niegisch, Cora N. Sternberg, Sandy Srinivas, Ulka Vaishampayan, Andrea Necchi, Michalis Liontos, Jonathan E. Rosenberg, Thomas Powles, Joaquim Bellmunt, Matthew D. Galsky
Institutions: National and Kapodistrian University of Athens, Dana-Farber Cancer Institute, University of Southampton, Fox Chase Cancer Center, City Of Hope National Medical Center, City of Hope, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Centre Georges François Leclerc, Hôpital Foch, University of Utah, University of Washington, Heinrich Heine University Düsseldorf, Azienda Ospedaliera San Camillo-Forlanini, Stanford Medicine, Stanford University, The Barbara Ann Karmanos Cancer Institute, Fondazione IRCCS Istituto Nazionale dei Tumori, Memorial Sloan Kettering Cancer Center, Queen Mary University of London, The Royal Free Hospital, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: National Cancer Institute
OpenAlex ID: W2933690530