RESEARCH ARTICLE


Efficacy of Different Second-line Therapy Regimens in Metastatic Urothelial Carcinoma



Lukas Barwitz, Anne Berger, Stefanie Zschaebitz, Max Jenzer, Cathleen Nientiedt, Stefan Duensing, Dirk Jäger, Dogu Teber, Markus Hohenfellner, Carsten Grüllich*
Department of Oncology, University Heidelberg Oncology, Heidelberg, Germany


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© Barwitz et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Oncology, University Heidelberg Oncology, Heidelberg, Germany; Tel: 49(0)62215637125; E-mail: carsten.gruellich@med.uni-heidelberg.de


Abstract

Introduction:

Metastatic Urothelial Cancer (UC) has a reported survival from platinum based chemotherapy of 15 months. Second line chemotherapy is considered relatively ineffective. Recently, new immuno-oncology drugs have been introduced.

Objectives:

Aim of this study was to analyze the survival by regimen and metastatic sites of second line treatment for UC.

Methods:

We analysed 70 patient receiving second line therapy between January 2010 and December 2016 at Heidelberg University Hospital. Median age was 60.9 years, male to female distribution was 74,3% to 25,7%. Regimens used were vinflunine (n=40, 57,1%) taxane based (n=20, 28,6%) and immunotherapy (n=9, 12,9%).

Results:

Median overall survival (OS) from first line therapy over all lines was 28,0 months. Median OS from second line was 14,7 months (95% CI, 11,4-18,0). No significant differences between regimens could be detected. OS of patients with lymphonodal only involvement (n=16, 22,5%) was 35.5 months (95% CI 0.0-73.9), OS with visceral metastases excluding liver was 14.7 months (95% CI 9.8-19.6) .and OS with any liver involvement was 9.4 months (95% CI 0.0-20.9).

Conclusion:

Second line therapy for UC of selected patients leads to a prolonged survival compared to historical data. The choice of regimen appears not to influence OS. Lymphnodal only involvement is associated with the best prognosis.

Keywords: Urothelial cancer, Second line therapy, Vinflunine, Taxane, Immuno-oncology, Lymphonadal.