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Current status of systemic chemotherapy for octogenarians with advanced urothelial cancer in Japan: a Japanese multi-institutional study (CURE study)

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Abstract

Background

The standard regimen of systemic chemotherapy for patients with advanced urothelial cancer (UC) changed from methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) to gemcitabine and cisplatin (GC) in 2008 when the use of gemcitabine for UC began to be reimbursed by public health insurance in Japan. We examined its influence on the chemotherapy trend in elderly patients aged ≥80 years.

Methods

Among 345 patients included in our previous multicenter retrospective cohort study (chemotherapy for urothelial carcinoma: renal function and efficacy study; CURE study), the outcome of 30 patients aged ≥80 years was reviewed before and after 2008 and compared with 315 young patients.

Results

There were only 7 (4.6 %) elderly individuals among all registered patients before 2008, whereas the number increased to 23 (12 %) after 2008. Before 2008, only one elderly patient received MVAC, while GC (whose rate was similar to the rate in young patients) was administered to 13 patients (56.5 %) after 2008. The chemotherapeutic effect and overall survival (OS) rate was not significantly different between young and elderly patients. In the elderly treated with the GC regimen, the renal impairment rate after the first cycle was significantly higher, and the presence of distant metastases and renal impairment were independent prognostic factors in a multivariate analysis.

Conclusion

Since GC was approved as the standard regimen for first-line chemotherapy in UC, selected elderly patients have been able to safely receive systemic chemotherapy like young patients. The clinical response rate and OS rate were similar to the young, but we need to monitor changes in renal function more closely in the elderly treated with GC.

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Abbreviations

UC:

Urothelial carcinoma

GC:

Gemcitabine and cisplatin

MVAC/MEC:

Methotrexate, vinblastine, adriamycin, and cisplatin/methotrexate, epirubicin, and cisplatin

GP:

Gemcitabine and paclitaxel

CR:

Complete response

PR:

Partial response

PD:

Progressive disease

NC:

No change

MDRD:

Modification of Diet in Renal Disease

PS:

Performance status

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Author information

Authors and Affiliations

  1. Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8501, Japan

    Yoshiyuki Matsui & Osamu Ogawa

  2. Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Ryutaro Ishitsuka, Jun Miyazaki & Hiroyuki Nishiyama

  3. Department of Urology, Akita University Graduate School of Medicine, Akita, 010-8502, Japan

    Takamitsu Inoue

  4. Department of Urology, Shiga University of Medical Science, Shiga, 520-2192, Japan

    Susumu Kageyama

  5. Department of Urology, Kagawa University, Faculty of Medicine, Kagawa, 761-0701, Japan

    Mikio Sugimoto

  6. Department of Urology, Tohoku University, Graduate School of Medicine, Miyagi, 980-8575, Japan

    Koji Mitsuzuka

  7. Department of Urology, Hyogo College of Medicine, Hyogo, 663-8501, Japan

    Yusuke Shiraishi

  8. Department of Urology and Andrology, Kansai Medical University, Osaka, 573-1191, Japan

    Hidefumi Kinoshita

  9. Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan

    Hironobu Wakeda

  10. Department of Urology, Tokai University School of Medicine, Kanagawa, 259-1193, Japan

    Takeshi Nomoto

  11. Department of Urology, Keio University School of Medicine, Tokyo, 160-8582, Japan

    Eiji Kikuchi

  12. Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan

    Keiko Fujie

  13. Tsukuba Clinical Research and Development Organization, University of Tsukuba, Ibaraki, 305-8575, Japan

    Keiko Fujie & Naoto Keino

Authors
  1. Yoshiyuki Matsui
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  2. Osamu Ogawa
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  3. Ryutaro Ishitsuka
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  4. Jun Miyazaki
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  5. Takamitsu Inoue
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  6. Susumu Kageyama
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  7. Mikio Sugimoto
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  8. Koji Mitsuzuka
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  9. Yusuke Shiraishi
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  10. Hidefumi Kinoshita
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  11. Hironobu Wakeda
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  12. Takeshi Nomoto
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  13. Eiji Kikuchi
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  14. Keiko Fujie
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  15. Naoto Keino
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  16. Hiroyuki Nishiyama
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Corresponding author

Correspondence to Yoshiyuki Matsui.

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The authors declare that they have no conflict of interest.

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Cite this article

Matsui, Y., Ogawa, O., Ishitsuka, R. et al. Current status of systemic chemotherapy for octogenarians with advanced urothelial cancer in Japan: a Japanese multi-institutional study (CURE study) . Int J Clin Oncol 21, 1142–1149 (2016). https://doi.org/10.1007/s10147-016-1007-8

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  • DOI: https://doi.org/10.1007/s10147-016-1007-8

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