Triplet chemotherapy with paclitaxel, gemcitabine, and cisplatin as second-line therapy for advanced urothelial carcinoma

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;.

DOI: 10.4236/mc.2013.21001                

Abstract

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.

Keywords

Metastatic Urothelial Carcinoma; Second-Line; Paclitaxel; Gemcitabine

Conflicts of Interest

The authors declare no conflicts of interest.

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