Utilization of Systemic Chemotherapy in Advanced Urothelial Cancer: A Retrospective Collaborative Study by the Hellenic Genitourinary Cancer Group (HGUCG).
BACKGROUND
Advanced urothelial cancer (AUCa) is associated with poor long-term survival. Two major concerns are related to nonexposure to cisplatin-based chemotherapy and poor outcome after relapse. Our purpose was to record patterns of practice in AUCa in Greece, focusing on first-line treatment and management of relapsed disease.


METHODS
Patients with AUCa treated from 2011 to 2013 were included in the analysis. Fitness for cisplatin was assessed by recently established criteria.


RESULTS
Of 327 patients treated with first-line chemotherapy, 179 (55%) did not receive cisplatin. Criteria for unfitness for cisplatin were: Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, 21%; creatinine clearance ≤ 60 mL/min, 55%; hearing impairment, 8%; neuropathy, 1%; and cardiac failure, 5%. Forty-six patients (27%) did not fulfill any criterion for unfitness for cisplatin. The main reasons for these deviations were comorbidities (28%) and advanced age (32%). Seventy-four (68%) of 109 patients who experienced a relapse received second-line chemotherapy. The most frequent reason for not offering second-line chemotherapy was poor PS or limited life expectancy (66%).


CONCLUSION
In line with international data, approximately 50% of Greek patients with AUCa do not receive cisplatin-based chemotherapy, although 27% of them were suitable for such treatment. In addition, about one third of patients with relapse did not receive second-line chemotherapy because of poor PS or short life expectancy. Enforcing criteria for fitness for cisplatin and earlier diagnosis of relapse represent 2 targets for improvement in current treatment practice for AUCa.
['Bamias|Aristotle|A|', 'Peroukidis|Stavros|S|', 'Stamatopoulou|Sophia|S|', 'Tzannis|Kimon|K|', 'Koutsoukos|Konstantinos|K|', 'Andreadis|Charalambos|C|', 'Bozionelou|Vasiliki|V|', 'Pistalmatzian|Nikos|N|', 'Papatsoris|Athanasios|A|', 'Stravodimos|Konstantinos|K|', 'Varthalitis|Ioannis|I|', 'Karamouzis|Michalis|M|', 'Milaki|Georgia|G|', 'Agorastos|Antonios|A|', 'Kentepozidis|Nikos|N|', 'Androulakis|Nikos|N|', 'Bompolaki|Iliada|I|', 'Kalofonos|Haralampos|H|', 'Mavroudis|Dimitrios|D|', 'Dimopoulos|Meletios A|MA|']
D000368:Aged D000369:Aged, 80 and over D000971:Antineoplastic Combined Chemotherapy Protocols D002945:Cisplatin D005260:Female D006115:Greece D006801:Humans D008297:Male D008875:Middle Aged D011379:Prognosis D012008:Recurrence D012189:Retrospective Studies D012307:Risk Factors D016019:Survival Analysis D016896:Treatment Outcome D014571:Urologic Neoplasms D019459:Urothelium
Advanced urothelial cancer Patterns of practice Fitness for cisplatin