Author(s)

Hideki Takeshita, Koji Chiba, Sachi Kitayama, Shingo Moriyama, Rika Omura, Akira Noro

Department of Pharmacy, Saitama Red Cross Hospital, Saitama, Japan.
Department of Urology, Saitama Red Cross Hospital, Saitama, Japan;.

Background: Methotrexate, vinblastine, doxorubicin, and cisplatin regimen, and gemcitabine and cisplatin regimen are widely used for advanced or metastatic urothelial carcinomas (UCs). However, a standard treatment for patients who fail these firstline chemotherapies is unavailable. We examined the efficacy and safety of secondline paclitaxel, gemcitabine, and cisplatin (PCG) chemotherapy in Japanese patients. Methods: Between 2004 and 2010, 25 patients with metastatic UCs who failed to respond to platinumbased regimens were treated with PCG. They received intravenous paclitaxel (60 mg/m²) and gemcitabine (1000 mg/m²) on days 1 and 8, and cisplatin (70 mg/m²) on day 2 of every 21 day course. We retrospectively collected patients’ clinical and pathological data and evaluated adverse effects and survivals. Results: Patients underwent 95 PCG cycles in all (average, 3.8 cycles per patient). One patient (4%) achieved complete response, 5 (20%) showed partial response, 8 (42%) had disease stabilization, and 5 (26%) had disease progression. Median overall survival was 8.5 months. Neutropenia and thrombocytopenia of grade ≥ 3 were observed in 68% and 56% of patients, respectively. No treatment related death occurred. Multivariate analysis revealed that hemoglobin levels < 10 g/dL and estimated glomerular filtration rate < 60 mL/(min1.73 m²) were significant risk factors for overall survival. Conclusion: PCG chemotherapy in the secondline setting potentially contributed to good prognosis in selected patients with relatively significant but tolerable toxicity.

Metastatic Urothelial Carcinoma; Second-Line; Paclitaxel; Gemcitabine

Takeshita, H., Chiba, K., Kitayama, S., Moriyama, S., Omura, R. and Noro, A. (2013) Triplet chemotherapy with paclitaxel, gemcitabine, and cisplatin as second-line therapy for advanced urothelial carcinoma. Modern Chemotherapy, 2, 1-7. doi: 10.4236/mc.2013.21001.