Document Detail

Treatment of patients with metastatic urothelial cancer "unfit" for Cisplatin-based chemotherapy.
MedLine Citation:
PMID:  21555688     Owner:  NLM     Status:  MEDLINE    
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.
Matthew D Galsky; Noah M Hahn; Jonathan Rosenberg; Guru Sonpavde; Thomas Hutson; William K Oh; Robert Dreicer; Nicholas Vogelzang; Cora N Sternberg; Dean F Bajorin; Joaquim Bellmunt
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Publication Detail:
Type:  Journal Article; Review     Date:  2011-05-09
Journal Detail:
Title:  Journal of clinical oncology : official journal of the American Society of Clinical Oncology     Volume:  29     ISSN:  1527-7755     ISO Abbreviation:  J. Clin. Oncol.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-09     Completed Date:  2011-08-12     Revised Date:  2011-11-09    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2432-8     Citation Subset:  IM    
Mount Sinai School of Medicine, Tisch Cancer Institute, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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MeSH Terms
Antineoplastic Agents / therapeutic use*
Carboplatin / therapeutic use
Cisplatin / therapeutic use*
Clinical Trials, Phase II as Topic
Clinical Trials, Phase III as Topic
Kidney / physiopathology
Neoplasm Metastasis
Urologic Neoplasms / drug therapy*,  pathology,  physiopathology
Urothelium / pathology
Reg. No./Substance:
0/Antineoplastic Agents; 15663-27-1/Cisplatin; 41575-94-4/Carboplatin
Comment In:
J Clin Oncol. 2011 Oct 10;29(29):3945   [PMID:  21900111 ]

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