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Review
. 2011 Jun 10;29(17):2432-8.
doi: 10.1200/JCO.2011.34.8433. Epub 2011 May 9.

Treatment of patients with metastatic urothelial cancer "unfit" for Cisplatin-based chemotherapy

Matthew D Galsky  1 , Noah M Hahn, Jonathan Rosenberg, Guru Sonpavde, Thomas Hutson, William K Oh, Robert Dreicer, Nicholas Vogelzang, Cora N Sternberg, Dean F Bajorin, Joaquim Bellmunt
Affiliations
Review

Treatment of patients with metastatic urothelial cancer "unfit" for Cisplatin-based chemotherapy

Matthew D Galsky et al. J Clin Oncol. .

Abstract

Purpose: Cisplatin-based combination chemotherapy is considered standard first-line treatment for patients with metastatic urothelial carcinoma. However, a large proportion of patients with metastatic urothelial carcinoma are considered "unfit" for cisplatin. The purpose of this review is to define unfit patients and to identify treatment options for this subgroup of patients.

Patients and methods: In this review, the criteria used to define unfit patients are explored and the results of prospective clinical trials evaluating chemotherapeutic regimens in unfit patients are summarized.

Results: Several phase II trials and a single, large phase III trial have explored chemotherapeutic regimens for the treatment of unfit patients with metastatic urothelial carcinoma. Heterogeneous eligibility criteria have been used to define unfit patients in these studies. A uniform definition of unfit is proposed on the basis of the results of a survey of genitourinary medical oncologists. According to this definition, unfit patients would meet at least one of the following criteria: Eastern Cooperative Oncology Group performance status of 2, creatinine clearance less than 60 mL/min, grade ≥ 2 hearing loss, grade ≥ 2 neuropathy, and/or New York Heart Association Class III heart failure.

Conclusion: Additional studies to optimize treatment for this important subset of patients are needed. A uniform definition of unfit patients will lead to more uniform clinical trials, enhanced ability to interpret the results of these trials, and a greater likelihood of developing a viable strategy for regulatory approval.

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Comment in

  • "Unfit" for Cisplatin: on basis of which GFR?
    Dizdar O, Demirci U, Ozcan MF. Dizdar O, et al. J Clin Oncol. 2011 Oct 10;29(29):3945. doi: 10.1200/JCO.2011.37.6640. Epub 2011 Sep 6. J Clin Oncol. 2011. PMID: 21900111 No abstract available.

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