Cisplatin-Based First-Line Therapy for Advanced Urothelial Carcinoma After Previous Perioperative Cisplatin-Based Therapy

Longer time from previous perioperative chemotherapy (TFPC) >= 78 weeks and Eastern Cooperative Oncology Group (ECOG) performance status (PS) = 0 were independently prognostic for better survival with cisplatin-based first-line chemotherapy for advanced urothelial carcinoma (UC) after previous perioperative cisplatin-based chemotherapy. Because of particularly poor outcomes in those with TFPC < 52 weeks, the data support using TFPC >= 52 weeks to rechallenge with cisplatin-based first-line chemotherapy for metastatic disease. Background: Outcomes with cisplatin-based first-line therapy for advanced UC after previous perioperative cisplatin-based chemotherapy are unclear. In this study we evaluated outcomes with a focus on the effect of time from previous cisplatin-based perioperative chemotherapy. Patients and Methods: Data were collected for patients who received cisplatin-based first-line therapy for advanced UC after previous perioperative cisplatin-based therapy. Cox proportional hazards models were used to investigate the prognostic ability of visceral metastasis, ECOG PS, TFPC, anemia, leukocytosis, and albumin on overall survival (OS). Results: Data were available for 41 patients from 8 institutions including 31 men (75.6%). The median age was 61 (range, 41-77) years, most received gemcitabine plus cisplatin (n = 26; 63.4%), and the median number of cycles was 4 (range, 1-8). The median OS was 68 weeks (95% confidence interval [CI], 48.0-81.0). Multivariable Cox regression analysis results showed an independent prognostic effect on OS for PS > 0 versus 0 (hazard ratio [HR], 4.56 [95% CI, 1.66-12.52]; P = .003) and TFPC >= 78 weeks versus < 78 weeks (HR, 0.48 [95% CI, 0.21-1.07]; P = .072). The prognostic model for OS was internally validated with c-index = 0.68. Patients with TFPC < 52 weeks, 52 to 104 weeks, and >= 104 weeks had median survival of 42, 70, and 162 weeks, respectively. Conclusion: Longer TFPC >= 78 weeks and ECOG PS = 0 were independently prognostic for better survival with cisplatin-based first-line chemotherapy for advanced UC after previous perioperative cisplatin-based chemotherapy. The data support using TFPC >= 52 weeks to rechallenge with cisplatin-based first-line chemotherapy for metastatic disease.