Vinflunine treatment in patients with metastatic urothelial cancer: A Nordic retrospective multicenter analysis

Abstract

In 2009, vinflunine was introduced as a second-line treatment to be used after the failure of platinum therapy in patients with metastatic urothelial carcinoma (mUC). The present study investigated the administered vinflunine to patients with mUC in standard clinical practice with the aim of evaluating treatment patterns, response, survival parameters and side-effects. Data were collected retrospectively from the first 100 mUC patients treated with vinflunine at three Nordic cancer centers associated with the Nordic Urothelial Cancer Oncology Group. The overall response rate was 23% and complete response was observed in one patient. The median progression-free survival (mPFS) and median overall survival (mOS) were 2.8 (range, 0.5–34.3) and 6.3 (range, 0.3–39.7) months, respectively. An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2 was present in 20% of the patients, and those patients exhibited significantly shorter mOS (4.1 vs. 7.0 months, P=0.001) and a significantly higher degree of grade 3/4 toxicity (P=0.026) compared with ECOG PS 0–1 patients. Furthermore, patients without visceral metastases had significantly longer mOS than patients with visceral metastases (10.6 vs. 6.0 months, P=0.008). The median number of cycles of vinflunine was 3 (range, 1–28). The current data confirms that vinflunine is an active agent for second-line treatment in an unselected clinical cohort of patients with mUC. ECOG PS and presence of visceral metastases were significant prognostic parameters. In particular, patients with ECOG PS 2 receiving vinflunine had a shorter mOS and a higher frequency of severe toxicity, and, thus, should be treated with caution. Furthermore, the present study observed large inter-individual differences in radiological response and OS, indicating the need for further development of improved patient selection tools to optimize vinflunine treatment in platinum-refractory mUC patients.

Emerging Cytotoxic Alkaloids in the Battle against Cancer: Overview of Molecular Mechanisms

“…On the other hand, vincristine, derived from the leaves of the plant Catharanthus roseus (L.) G.Don. (formerly, Vinca rosea ), has anti-microtubule effects on the cells of metastatic urothelial carcinoma [ 69 ] and breast cancer [ 70 ]. Nevertheless, there are reports of peripheral neuropathy associated with taxol [ 68 ]; neurotoxicity and few reports of blindness related to vincristine [ 71 ]; and anemia and neutropenia accompanying vinflunine [ 69 ].…”

Vinflunine in the Τreatment of Upper Tract Urothelial Carcinoma – Subgroup Analysis of an Observational Study

“…Considering additionally the scarcity of controlled clinical trials in these patients, non-interventional studies and retrospective analyses all the more contribute to valid efficiency and safety evaluations of treatment modalities and thus are important tools for the development of treatment recommendations. In comparison, several non-interventional studies focusing on vinflunine treatment after platinum-based chemotherapy have been conducted in other European countries and showed comparable results (21)(22)(23)(24)(25)(26). Most frequently reported grade 3/4 AEs were neutropenia (2-23%), anemia (4-33%), fatigue (1-36%), and constipation (5-22%).…”

Maintenance treatment with gemcitabine have a promising activity on metastatic bladder cancer survival

“…The first computed tomography (CT) scan or 18 F-FDG PET/CT was performed prior to treatment and follow-up CT scans or 18 F-FDG PET/CT were performed every 9 weeks (every three cycles) or in case of clinically suspected progression. PFS was defined as the interval between the beginning of chemotherapy to progression or discontinuation of treatment due to any cause.…”

“…[15] Moreover, after failure of cisplatin-based first-line therapy, there have been just a few agents such as eribulin, taxanes, vinflunine, and pemetrexed which resulted in a low response rate about 7 to 38%. [16][17][18][19] In addition to low survival rates obtained with these agents, disease progression inavoidable occurs just after discontinuing the first-line chemotherapy. Consequently, it is necessary to find more effective and tolerable treatments to delay disease progression and improve survival in advanced bladder cancer.…”