Impact of Response to Prior Chemotherapy in聽Patients With Advanced Urothelial Carcinoma Receiving Second-Line Therapy: Implications for聽Trial Design

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• 作者：Gregory R. Pond ; Joaquim Bellmunt ; Ronan Fougeray ; Toni K. Choueiri ; Angela Q. Qu ; Guenter Niegisch ; Peter Albers ; Giuseppe Di Lorenzo ; Yacine Salhi ; Matthew D. Galsky ; Neeraj Agarwal ; Andrea Necchi ; Guru Sonpavde
• 关键词：Advanced urothelial carcinoma ; Prognostic factors ; Response to prior chemotherapy ; Second-line therapy
• 刊名：Clinical Genitourinary Cancer
• 出版年：December, 2013
• 年：2013
• 卷：11
• 期：4
• 页码：495-500
• 全文大小：326 K

文摘

Background

The prognostic impact of response to prior chemotherapy independent of performance status (PS), hemoglobin (Hb), liver metastasis (LM), and time from prior chemotherapy (TFPC) in the context of second-line therapy for advanced urothelial carcinoma (UC) is unknown.

Methods

Six phase II trials evaluating second-line therapy (n聽=聽504) were pooled. Patients who received prior therapy for metastatic disease were eligible for analysis if Hb, LM, PS, and TFPC were available. Response by Response Evaluation Criteria in Solid Tumors 1.0 to first-line therapy was recorded. Progression-free survival (PFS) and overall survival (OS) were calculated from the date of registration using the Kaplan-Meier method.

Results

A total of 275 patients were evaluable for analysis. Patients received gemcitabine-paclitaxel, cyclophosphamide-paclitaxel, pazopanib, docetaxel plus vandetanib/placebo, or vinflunine (2 trials). Those with prior response (n聽= 111) had a median OS of 8.0 months (95% confidence interval [CI], 6.8-9.4), compared with 5.9 months (95% CI, 5.0-6.6) for those without prior response (n聽= 164). Those with prior response had a median PFS of 3.0 months (95% CI, 2.6-4.0) compared with 2.6 months (95% CI, 2.0-2.8) in patients without response. Multivariable analysis did not reveal a significant independent impact of prior response on PFS and OS.

Conclusions

Best prior response in patients receiving prior chemotherapy for metastatic disease did not confer an independent prognostic impact with second-line therapy for advanced UC. Given that the setting of prior chemotherapy (metastatic or perioperative) has not appeared significant in a prior study, patients who received prior chemotherapy in perioperative or metastatic settings may be enrolled in the same second-line trial stratified for PS, Hb, LM, and TFPC.