Izumi Kouji, Iwamoto Hiroaki, Yaegashi Hiroshi, Shigehara Kazuyoshi, Nohara Takahiro, Kadono Yoshifumi, Mizokami Atsushi
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
In Vivo. 2019 Jan-Feb;33(1):167-172. doi: 10.21873/invivo.11454.
Combination chemotherapy with gemcitabine and cisplatin is the standard first-line treatment for advanced urinary tract urothelial cancer. Carboplatin is often substituted for cisplatin in patients who are cisplatin-ineligible, such as those with a glomerular filtration rate less than 60 ml/min. However, carboplatin-based chemotherapy has not been not confirmed as meeting the standard of care based on randomized controlled trials, and it is still unclear whether carboplatin can offer prognosis comparable to that with cisplatin.
Patients with advanced urothelial cancer who underwent gemcitabine/cisplatin (GC) split or gemcitabine/ carboplatin (GCarbo) for renal dysfunction with a glomerular filtration rate of approximately 40-60 ml/min between 2008 and 2015 were chosen and reviewed using their charts. Patients with normal renal function treated with GC were also reviewed as a reference group.
A total of 41 patients, including 10 treated with GCsplit, 16 treated with GCarbo, and 15 treated with GC, were analyzed. The median overall and progression-free survival in GCsplit and GCarbo groups were 18.1 and 12.5 months (p=0.0454) and 9.9 and 6.4 months (p=0.0404), respectively. Neutropenia was relatively more severe in the GCsplit group than the GCarbo group (p=0.0103).
GCsplit may be a better treatment option for patients with advanced urothelial cancer with cisplatin-ineligible renal function. However, a prospective randomized controlled trial with a large-sized population is warranted to confirm our preliminary results.
吉西他滨和顺铂联合化疗是晚期尿路上皮癌的标准一线治疗方案。对于顺铂不适用的患者，如肾小球滤过率低于60 ml/min的患者，常常用卡铂替代顺铂。然而，基于随机对照试验，以卡铂为基础的化疗尚未被确认为符合治疗标准，卡铂是否能提供与顺铂相当的预后仍不清楚。
选择2008年至2015年间因肾功能不全（肾小球滤过率约为40 - 60 ml/min）接受吉西他滨/顺铂（GC）分阶段给药或吉西他滨/卡铂（GCarbo）治疗的晚期尿路上皮癌患者，并查阅其病历。接受GC治疗的肾功能正常患者也作为参照组进行查阅。
共分析了41例患者，包括10例接受GC分阶段给药治疗、16例接受GCarbo治疗和15例接受GC治疗的患者。GC分阶段给药组和GCarbo组的中位总生存期和无进展生存期分别为18.1个月和12. months（p = 0.0454）以及9.9个月和6.4个月（p = 0.0404）。GC分阶段给药组的中性粒细胞减少相对比GCarbo组更严重（p = 0.0103）。
对于肾功能不适合顺铂治疗的晚期尿路上皮癌患者，GC分阶段给药可能是更好的治疗选择。然而，需要进行一项有大量人群参与的前瞻性随机对照试验来证实我们的初步结果。
