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: 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:



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.


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


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%).


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).


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.