Tolerability of Gemcitabine Plus Cisplatin for Treatment of Urothelial Cancer in the Elderly Population

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Abstract

The optimal dosing of gemcitabine plus cisplatin for urothelial cancer in patients aged ≥ 65 years is unknown. We reviewed the data from 28 patients, most of whom received gemcitabine plus cisplatin in the neoadjuvant setting. The most common dose used was gemcitabine 1250 mg/m2 given on days 1 and 8 plus cisplatin 70 mg/m2 on day 1 every 21 days. A lower gemcitabine dose of 1000 mg/m2 was better tolerated with fewer treatment delays.

Background:

Gemcitabine plus cisplatin is the standard of care for metastatic urothelial cancer and is frequently used in the neoadjuvant and adjuvant setting as well. However, the optimal dose and schedule for patients aged ≥ 65 years is not clear.

Patients and Methods:

We performed a retrospective study to determine the tolerability of gemcitabine plus cisplatin for treatment of urothelial cancer in the elderly population. A total of 28 patients aged ≥ 65 years with urothelial cancer treated with gemcitabine plus cisplatin on a 21-day schedule from January 1, 2008 to August 31, 2013 were included in the present study.

Results:

Of the 28 patients, 16 (57.1%) received gemcitabine plus cisplatin in the neoadjuvant setting. The most common dosing regimen was gemcitabine 1250 mg/m2 given on days 1 and 8 plus cisplatin 70 mg/m2 on day 1 every 21 days, with some receiving gemcitabine at a dose of 1000 mg/m2. The primary reason behind the dose modifications and treatment delays with the higher gemcitabine dose was hematologic toxicity. Two patients discontinued treatment because of renal dysfunction, with one developing a grade 4 elevation in serum creatinine. One patient developed febrile neutropenia; however, this patient did not receive growth factor support for primary prophylaxis of febrile neutropenia.

Conclusion:

Gemcitabine plus cisplatin overall is a reasonably well-tolerated treatment regimen for patients aged ≥ 65 years. The results of the present study support the use of a lower gemcitabine dose of 1000 mg/m2, because it was better tolerated.

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