Outcome and prognostic factors in metastatic urothelial carcinoma patients receiving second-line chemotherapy: an analysis of real-world clinical practice data in Japan

Abstract

We revealed prognostic factors in metastatic urothelial carcinoma patients treated with second-line systemic chemotherapy in real-world clinical practice. Performance status, C-reactive protein level and response to prior chemotherapy were prognostic indicators.

Survival Benefit for Patients With Metastatic Urothelial Carcinoma Receiving Continuous Maintenance Chemotherapy

“…The median survival time for our MUC patients receiving continuous maintenance chemotherapy was 17 months, with no difference between bladder and upper urinary tract cancer location (18 versus 17 months). The survival time was compatible with previous reports (1,13,14). Patient survival was likely related not only to the objective tumor response, but also to inflammation and coagulopathy as major contributory factors to patient death, as demonstrated by the inflammation-related symptoms and cause of death.…”

“…Urothelial carcinoma is a chemo-sensitive cancer. The median overall survival (OS) time of metastatic urothelial carcinoma (MUC) patients is 17 months following systemic chemotherapy according to a Japanese study (1). In our previous report of bladder urothelial carcinoma, with peritoneal involvement receiving continuous maintenance chemotherapy, the median OS time was 28 months (2).…”

Skeletal Muscle Mass Reduction Velocity as a Simple Prognostic Indicator for Patients with Metastatic Urothelial Carcinoma Receiving Second-Line Chemotherapy

“…Favorable PS, female gender, hemoglobin level > 10 g/dl, and single organ metastasis were previously reported to be favorable prognostic factors among Japanese mUC patients treated with systemic chemotherapy (Abe et al, 2016). Moreover, the ECOG PS at presentation, CRP level and response to prior chemotherapy were reported as prognostic factors for mUC patients undergoing second-line chemotherapy (Matsumoto et al, 2018). In the setting of second-line chemotherapy, time from prior chemotherapy, alkaline phosphatase, visceral involvement and liver metastasis are also reported as worse prognosis of predictive factor (Bellmunt et al, 2009, Sonpavde et al, 2013.…”

Pembrolizumab versus chemotherapy in recurrent, advanced urothelial cancer in Japanese patients: a subgroup analysis of the phase 3 KEYNOTE-045 trial

“…Pembrolizumab is approved for second-line treatment of patients with advanced/metastatic UC in Japan [12]; however, there are no clear guidelines on choosing second-line therapy for these patients. In clinical practice, a variety of combination and single-agent therapies are prescribed [9,10,28]. One small study was conducted to evaluate second-line combinations of gemcitabine and taxanes in Japanese patients with metastatic UC that progressed after platinum-based chemotherapy (N = 78) [28].…”

“…However, the gemcitabine plus cisplatin regimen is preferred because of a more favorable tolerability profile [8]. No recommendation has been made regarding second-line treatment or treatment of patients ineligible for platinum-based therapy, and a variety of combination and single-agent treatments are used in the management of UC in clinical practice in Japan [8][9][10].…”