Time from prior chemotherapy enhances prognostic risk grouping in the second-line setting of advanced urothelial carcinoma: A retrospective analysis of pooled, prospective phase 2 trials

Guru Sonpavde, Gregory R. Pond, Ronan Fougeray, Toni K. Choueiri, Angela Q. Qu, David J. Vaughn, Guenter Niegisch, Peter Albers, Nicholas D. James, Yu Ning Wong, Yoo Joung Ko, Srikala S. Sridhar, Matthew D. Galsky, Daniel P. Petrylak, Ulka N. Vaishampayan, Awais Khan, Nicholas J. Vogelzang, Tomasz M. Beer, Walter M. Stadler, Peter H. O'DonnellCora N. Sternberg, Jonathan E. Rosenberg, Joaquim Bellmunt

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    68 Scopus citations

    Abstract

    Background: Outcomes for patients in the second-line setting of advanced urothelial carcinoma (UC) are dismal. The recognized prognostic factors in this context are Eastern Cooperative Oncology Group (ECOG) performance status (PS) >0, hemoglobin level (Hb) <10 g/dl, and liver metastasis (LM). Objectives: The purpose of this retrospective study of prospective trials was to investigate the prognostic value of time from prior chemotherapy (TFPC) independent of known prognostic factors. Design, setting, and participants: Data from patients from seven prospective trials with available baseline TFPC, Hb, PS, and LM values were used for retrospective analysis (n = 570). External validation was conducted in a second-line phase 3 trial comparing best supportive care (BSC) versus vinflunine plus BSC (n = 352). Outcome measurements and statistical analysis: Cox proportional hazards regression was used to evaluate the association of factors, with overall survival (OS) and progression-free survival (PFS) being the respective primary and secondary outcome measures. Results and limitations: ECOG-PS >0, LM, Hb <10 g/dl, and shorter TFPC were significant prognostic factors for OS and PFS on multivariable analysis. Patients with zero, one, two, and three to four factors demonstrated median OS of 12.2, 6.7, 5.1, and 3.0 mo, respectively (concordance statistic = 0.638). Setting of prior chemotherapy (metastatic disease vs perioperative) and prior platinum agent (cisplatin or carboplatin) were not prognostic factors. External validation demonstrated a significant association of TFPC with PFS on univariable and most multivariable analyses, and with OS on univariable analyses. Limitations of retrospective analyses are applicable. Conclusions: Shorter TFPC enhances prognostic classification independent of ECOG-PS >0, Hb <10 g/dl, and LM in the setting of second-line therapy for advanced UC. These data may facilitate drug development and interpretation of trials.

    Original languageEnglish (US)
    Pages (from-to)717-723
    Number of pages7
    JournalEuropean Urology
    Volume63
    Issue number4
    DOIs
    StatePublished - Apr 1 2013

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    Keywords

    • Hemoglobin
    • Liver metastasis
    • Performance status
    • Prognosis
    • Second line
    • Time from prior chemotherapy
    • Urothelial carcinoma

    ASJC Scopus subject areas

    • Urology

    Cite this

    Sonpavde, G., Pond, G. R., Fougeray, R., Choueiri, T. K., Qu, A. Q., Vaughn, D. J., Niegisch, G., Albers, P., James, N. D., Wong, Y. N., Ko, Y. J., Sridhar, S. S., Galsky, M. D., Petrylak, D. P., Vaishampayan, U. N., Khan, A., Vogelzang, N. J., Beer, T. M., Stadler, W. M., ... Bellmunt, J. (2013). Time from prior chemotherapy enhances prognostic risk grouping in the second-line setting of advanced urothelial carcinoma: A retrospective analysis of pooled, prospective phase 2 trials. European Urology, 63(4), 717-723. https://doi.org/10.1016/j.eururo.2012.11.042