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Salvage treatment with low-dose weekly paclitaxel in elderly or poor performance status patients with metastatic urothelial carcinoma

Abstract

Aims and background. To evaluate the efficacy of weekly, low-dose paclitaxel chemotherapy after the failure of platinum-based combination chemotherapy in elderly or poor performance status patients with metastatic urothelial carcinoma.
Methods. We retrospectively reviewed the medical records of 25 patients. The regimen consisted of paclitaxel, 60 mg/m2 on days 1, 8 and 15, with or without carboplatin (AUC 2). Treatment was repeated every 4 weeks until disease progression.
Results. Of 25 patients, the median age was 68 years (range, 47-82), 4 (16%) were female, and 15 (60%) had an ECOG performance status of 2. All patients were ≥65 years or had a performance status of 2 in the cases aged >65 years. Six patients received paclitaxel in combination with carboplatin. The overall response rate was 24% (95% CI, 7.3-40.7) with 6 partial responses. Eight patients (32%) achieved stable disease and 5 (20%) had progressive disease. The median time to progression was 4.0 months (95% CI, 2.9-5.1), and median overall survival was 5.5 months (95% CI, 3.7-7.3). Grade 3-4 toxicities were as follows: neutropenia in 9 patients (36%), anemia in 11 (44%), thrombocytopenia in 2 (8%), neutropenic fever in 2 (8%), asthenia in 4 (16%), anorexia in 2 (8%), nausea in 2 (8%), and peripheral neuropathy in 1 (4%). ECOG performance status (0-1 vs 2) was a significant prognostic factor in multivariate analysis.
Conclusions. Low-dose weekly paclitaxel seems to be a meaningful salvage treatment with moderate activity and acceptable toxicity in elderly or poor performance status patients with metastatic urothelial carcinoma. Oncologists should carefully consider the opportunity of chemotherapy versus best supportive care in these patients.

Tumori 2014; 100(4): 439 - 445

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.1700/1636.17906

Authors

Jae Joon Han, Yu Jung Kim, Jin Won Kim, Hyun Chang, Jeong-Ok Lee, Keun-Wook Lee, Chang Wook Jeong, Jee Hyun Kim, Sung Kyu Hong, Soo-Mee Bang, Seok-Soo Byun, Sang Eun Lee, Jong Seok Lee

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Authors

  • Han, Jae Joon [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Kim, Yu Jung [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Kim, Jin Won [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Chang, Hyun [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Lee, Jeong-Ok [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Lee, Keun-Wook [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Jeong, Chang Wook [PubMed] [Google Scholar]
    Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Kim, Jee Hyun [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Hong, Sung Kyu [PubMed] [Google Scholar]
    Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Bang, Soo-Mee [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Byun, Seok-Soo [PubMed] [Google Scholar]
    Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Lee, Sang Eun [PubMed] [Google Scholar]
    Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
  • Lee, Jong Seok [PubMed] [Google Scholar]
    Departments of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

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