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What is the optimal number of chemo cycles for advanced urothelial carcinoma?

30 Nov 2018

It appears that four cycles of platinum-based, first-line chemotherapy are tolerable and do not significantly compromise the survival of patients with metastatic urothelial carcinoma, suggests a study.

A total of 1,020 patients were included, of whom 338 and 134 received cisplatin or carboplatin, respectively. Three to five cycles (median, four) of chemotherapy were given to 157 patients, while 315 received six to nine cycles (median, six).

Overall survival between the two cycles did not show any significant difference (hazard ratio, 1.02; 95 percent CI, 0.78–1.3; p=0.91). Moreover, there were no significant interactions for the type of platinum (p=0.09) and completed planned chemotherapy (p=0.56).

Limitations of a hypothesis-generating, retrospective analysis applied.

“The omission of excessive cycles may avoid unnecessary cumulative toxicity and facilitate a better transition to second line therapy and investigational switch maintenance therapy strategies,” the authors said. “These results require prospective validation, but they may impact practice in select patients.”

The RISC (Retrospective International Study of Invasive/Advanced Cancer of the Urothelium) database was accessed to identify patients in this study. The authors performed Cox multiple regression analysis, controlling for recognized prognostic factors, to examine the association between the number of cycles of chemotherapy and overall survival.

Patients who received fewer than three or more than nine platinum chemotherapy cycles were excluded to reduce confounding factors. Overall survival for three to five and six to nine cycles was the primary endpoint, using 6-month landmark analysis when 281 death events occurred.

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