Original Article

You have full text access to this OnlineOpen article

Sequential adjuvant chemotherapy after surgical resection of high-risk urothelial carcinoma†‡

  1. David J. Gallagher MD, BCH, BAO1,
  2. Matthew I. Milowsky MD1,2,
  3. Alexia Iasonos PhD3,
  4. Fernando C. Maluf MD1,
  5. Paul Russo MD4,
  6. Guido Dalbagni MD4,
  7. Machele S. Donat MD4,
  8. Mary G. Boyle RN1,
  9. Junting Zheng MS3,
  10. Jamie Riches BA1,
  11. Dean F. Bajorin MD1,2,§,*

Article first published online: 10 AUG 2009

DOI: 10.1002/cncr.24570

Issue

Cancer

Cancer

Volume 115, Issue 22, pages 5193–5201, 15 November 2009

Additional Information

How to Cite

Gallagher, D. J., Milowsky, M. I., Iasonos, A., Maluf, F. C., Russo, P., Dalbagni, G., Donat, M. S., Boyle, M. G., Zheng, J., Riches, J. and Bajorin, D. F. (2009), Sequential adjuvant chemotherapy after surgical resection of high-risk urothelial carcinoma. Cancer, 115: 5193–5201. doi: 10.1002/cncr.24570

Author Information

  1. 1

    Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

  2. 2

    Department of Medicine, Weill Medical College of Cornell University, New York, New York

  3. 3

    Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York

  4. 4

    Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

  1. §

    Fax: (212) 988-1079

*Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065

  1. †

    See related editorial on pages 5139-42, this issue.

  2. ‡

    Presented in part at the American Society of Clinical Oncology 2008 Genitourinary Cancers Symposium; San Francisco, California; February 14-16, 2008.

Publication History

  1. Issue published online: 3 NOV 2009
  2. Article first published online: 10 AUG 2009
  3. Manuscript Accepted: 15 DEC 2008
  4. Manuscript Revised: 11 DEC 2008
  5. Manuscript Received: 28 AUG 2008

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (209K)

Keywords:

  • urothelial cancer;
  • adjuvant chemotherapy;
  • dose-dense sequential therapy;
  • cystectomy;
  • nephroureterectomy;
  • disease-specific survival

Abstract

BACKGROUND:

Despite definitive surgery, the survival of patients with high-risk urothelial carcinoma (UC) is poor. Adjuvant cisplatin-based chemotherapy may be beneficial, but it is restricted by the need for normal renal function (RF). Sequential administration of adjuvant chemotherapy facilitates drug delivery and improves survival in patients with breast cancer. The objective of this study was to evaluate the feasibility and survival impact of adjuvant, sequential chemotherapy in patients with high-risk UC.

METHODS:

Fifty patients were treated on 2 simultaneous protocols between 1997 and 2004. The patients on Protocol A (normal RF) received doxorubicin and gemcitabine (AG) followed by paclitaxel and cisplatin. The patients on Protocol B (impaired RF) received AG followed by paclitaxel plus carboplatin. Overall survival (OS) and disease-specific survival (DSS) were compared with a group of 203 contemporary control patients who had similar pathology and RF and who underwent surgery alone.

RESULTS:

The median follow-up of protocol patients was 6.5 years (range, 0.9-8.6 years), and 25 patients remained alive. The median follow-up of the control group was 4.7 years (0.0-9.2), and 68 patients remained alive. The median OS for patients on Protocol A was greater than that for controls who had good RF (4.6 years vs 2.5 years; P = .03). The median OS for patients on Protocol B was greater than that for controls who had impaired RF (3.4 years vs 2 years; P = .04). DSS for the protocol and matched control groups was similar (good RF: 4.6 years vs 3 years; P = .24; impaired RF: 3.4 years vs 3.3 years; P = .40).

CONCLUSIONS:

In this nonrandomized study, adjuvant, sequential chemotherapy for patients with high-risk UC did not improve DSS over that observed with surgery alone. Cancer 2009. © 2009 American Cancer Society.

View Full Article (HTML) Get PDF (209K)