Department of Urology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan,
Int J Clin Oncol. 2013 Oct;18(5):910-5. doi: 10.1007/s10147-012-0466-9. Epub 2012 Aug 31.
This was a retrospective study to evaluate the activity and toxicity of a combined chemotherapeutic regimen of gemcitabine and carboplatin (GCa) in patients with metastatic urothelial carcinomas (UCs) with special regard to patients with highly impaired renal function.
Eleven patients whose creatinine clearance was 30 ml/min or under and who had been diagnosed with metastatic UC were treated with GCa. The patient cohort comprised 4 males and 7 females, with a median age of 74 (range 67-84) years. The median follow-up was 19 (range 1-58) months.
Five of the 11 patients (45%) showed an objective response, with 2 achieving a clinically complete response and 3 a partial response with GCa. The grade 3/4 toxicity of the regimen was primarily hematological, including anemia (55%), neutropenia (45%), and thrombocytopenia (45%). Four patients (36%) could not complete the treatment in total. Grade 3 pneumonitis was found in one patient, and the treatment was terminated. Grade 4 febrile neutropenia occurred in the patient on hemodialysis, and the patient was forced to discontinue the chemotherapy. Another 2 patients also called off the treatment due to a pulmonary adverse event and an elevation of serum creatinine, respectively.
GCa appears to be effective for the treatment of metastatic UCs in patients with impaired renal function, but it is necessary to pay attention to the occurrence of severe adverse events.
本研究回顾性评估了吉西他滨联合卡铂（GCa）化疗方案在合并严重肾功能不全的转移性尿路上皮癌（UC）患者中的疗效和毒性。
11 例肌酐清除率 30ml/min 或以下且确诊为转移性 UC 的患者接受了 GCa 治疗。患者队列包括 4 名男性和 7 名女性，中位年龄为 74 岁（范围 67-84 岁）。中位随访时间为 19 个月（范围 1-58 个月）。
11 例患者中有 5 例（45%）出现客观缓解，其中 2 例达到临床完全缓解，3 例部分缓解。该方案的 3/4 级毒性主要为血液学毒性，包括贫血（55%）、中性粒细胞减少（45%）和血小板减少（45%）。共有 4 例（36%）患者无法完成全部治疗。1 例患者出现 3 级肺炎，治疗终止。血液透析患者发生 4 级发热性中性粒细胞减少，患者被迫停止化疗。另外 2 例患者因肺部不良事件和血清肌酐升高分别终止治疗。
GCa 似乎对合并肾功能不全的转移性 UC 患者有效，但需注意严重不良事件的发生。
