Impact of contemporary patterns of chemotherapy utilization on survival in patients with advanced cancer of the urinary tract: A Retrospective International Study of Invasive/advanced cancer of the urothelium (RISC).

Abstract

BackgroundCisplatin-based combination chemotherapy is the standard treatment for advanced urinary tract cancer (aUTC) but 50% of patients are ineligible for cisplatin according to recently published criteria. We used a multinational database to study patterns of chemotherapy utilization in patients with aUTC and determine their impact on survival.Patients and MethodsThis was a retrospective study of patients with: UTC (bladder, renal pelvis, ureter or urethra); advanced disease (stages T4b and/or N+ and/or M+); urothelial, squamous or adenocarcinoma histology. Primary objective was overall survival (OS). Eligibility-for-cisplatin was defined by: Eastern Cooperative Oncology group (ECOG) performance status (PS)≤1, creatinine clearance (CrCl)≥60 ml/min, no hearing loss, no neuropathy, no heart failure. Cox regression multivariate analyses were used to establish independent associations of cisplatin vs. non-cisplatin-based chemotherapy on OS.Results1794 patients treated between 2000 and 2013 at 29 centers were analyzed. Median follow-up was 29.1 months. 1333 patients (74%) received 1^st-line chemotherapy: Use of 1^st-line chemotherapy was associated with longer OS: (Hazard ratio [HR]: 1.91, 95% confidence interval [CI]: 1.67-2.20). Type of 1st-line chemotherapy received was: cisplatin-based 669 (50%), carboplatin-based 399 (30%), other 265 (20%). Cisplatin use was an independent favorable prognostic factor (HR: 1.54, 95% CI: 1.35-1.77). This benefit was independent of baseline characteristics or co-morbidities but was associated with eligibility-for-cisplatin: eligible patients treated with cisplatin lived longer than those who were not (HR: 1.74, 95% CI: 1.36-2.21), while such benefit was not observed among ineligible patients. 26% of patients who did not receive cisplatin were eligible for this agent. Median OS of ineligible patients was poor irrespective of the chemotherapy used.ConclusionsThe importance of applying published criteria of eligibility-for-cisplatin was confirmed in a multinational, real-world setting in aUTC. The reasons for deviations from these criteria set targets to improve adherence. Effective therapies for cisplatin-ineligible patients are needed.