O'Dwyer Richard, Junker Sophia, Szulkin Robert, Kienzle Scarlette, Kearney Mairead, Sridhar Srikala S
Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
Cytel Inc., Potsdamer Strasse 58, 7th Floor, 10785 Berlin, Germany.
Cancers (Basel). 2025 Feb 3;17(3):509. doi: 10.3390/cancers17030509.
For many decades, gemcitabine + cisplatin has been a preferred and accepted treatment option for patients with urothelial cancer (UC). In patients ineligible for standard-dose cisplatin, split-dose cisplatin is a promising alternative. This study aimed to provide insights into the use of split-dose cisplatin and factors influencing treatment choice.
Between January and March 2024, an international cross-sectional survey was carried out, which involved oncologists and urologists treating patients with locally advanced/metastatic UC (la/mUC) in Australia, Brazil, Canada, France, Germany, India, Italy, Spain, the UK, and the USA. Demographics, practice patterns, and clinical parameters influencing treatment choice were collected.
Of the 791 respondents, most were male (73%), the mean age was 43 years, and the mean time spent in clinical practice was 13 years. In total, 85% reported using split-dose cisplatin in UC, ranging from 97% in Canada to 67% in Brazil. The preferred schedule in la/mUC was gemcitabine + cisplatin 35 mg/m on days 1 and 8 of 21-day cycles (57%). Most respondents (64%) were comfortable prescribing split-dose cisplatin to otherwise fit patients with a creatinine clearance ≥40 mL/min. Standard- and split-dose cisplatin were preferred regimens for otherwise fit patients with creatinine clearance of 45-60 mL/min.
This large international survey demonstrates the extensive use of split-dose cisplatin in patients with la/mUC. Responses indicate that split-dose cisplatin is administered to patients in clinical practice with a wider range of creatinine clearance, performance status, and comorbidities than suggested for standard-dose cisplatin. Results highlight the need to evaluate split-dose cisplatin prospectively and establish consensus guidelines for its use, especially in patients unfit for standard-dose cisplatin.
几十年来，吉西他滨联合顺铂一直是尿路上皮癌（UC）患者首选且被认可的治疗方案。对于不符合标准剂量顺铂治疗条件的患者，分剂量顺铂是一种有前景的替代方案。本研究旨在深入了解分剂量顺铂的使用情况以及影响治疗选择的因素。
2024年1月至3月期间，开展了一项国际横断面调查，涉及澳大利亚、巴西、加拿大、法国、德国、印度、意大利、西班牙、英国和美国治疗局部晚期/转移性UC（la/mUC）患者的肿瘤学家和泌尿科医生。收集了人口统计学、实践模式以及影响治疗选择的临床参数。
在791名受访者中，大多数为男性（73%），平均年龄为43岁，平均临床实践时间为13年。总体而言，85%的受访者报告在UC治疗中使用分剂量顺铂，加拿大的使用率为97%，巴西为67%。la/mUC中首选的给药方案是在21天周期的第1天和第8天使用吉西他滨联合35mg/m²顺铂（57%）。大多数受访者（64%）愿意为肌酐清除率≥40mL/min的一般状况良好的患者开具分剂量顺铂。对于肌酐清除率为45 - 60mL/min的一般状况良好的患者，标准剂量和顺铂分剂量方案是首选方案。
这项大型国际调查表明，分剂量顺铂在la/mUC患者中广泛使用。调查结果表明，在临床实践中接受分剂量顺铂治疗的患者，其肌酐清除率、体能状态和合并症范围比标准剂量顺铂适用的范围更广。结果强调需要对分剂量顺铂进行前瞻性评估，并建立其使用的共识指南，尤其是在不符合标准剂量顺铂治疗条件的患者中。
