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Phase II trial of sequential gemcitabine and carboplatin followed by paclitaxel as first-line treatment of advanced urothelial carcinoma. Presented by Celine BOUTROS Hotel- Dieu de France. Background. Bladder cancer is the 4 th cancer in men, the 9 th in women
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Phase II trial of sequential gemcitabine and carboplatin followed by paclitaxel as first-line treatment of advanced urothelial carcinoma Presented by Celine BOUTROS Hotel-Dieu de France
Background • Bladder cancer is the 4th cancer in men, the 9th in women • 69,000 new cases diagnosed in the US in 2008 • Transitional Cell Carcinoma (TCC): most frequent histological subtype • The standard first-line regimen in advanced TCC: - 1989-2000: Methotrexate, Vinblastine, Doxorubicin, Cisplatin (MVAC)1 - > 2000: Gemcitabine plus Cisplatin2 : similar activity, less toxicity • 1 Sternberg CN et al. Cancer 1989;64:2448-2458.2 Von der Maase H et al. J Clin Oncol 2000;18:3068-3077.
Objectives of the study Primary objective • Explore the activity of Gemcitabine plus Carboplatin (GC) followed sequentially with Paclitaxel in advanced TCC Secondary objective • Assess the toxicity profile of the regimen
Materials and Methodseligibility Single-Arm, Multicenter, Phase II trial, from September 2004 to September 2007 • Eligibility Criteria: • At least one dimensionally measurable disease • Locally advanced or metastatic disease • Histological infiltrative urothelial cancer • No prior chemotherapy unless given in more than one year free-interval • No prior radiation therapy • Performance status (PS) ≤ 2 • Adequate blood counts and chemistries • Normal organ function
Materials and Methodstreatmentschedule Gemcitabine 800mg/m2 (D1, D8) + Carboplatin AUC 2 (D1, D8) Every 3 weeks for 4 cycles Paclitaxel 60 mg/m2 weekly for 12 weeks Evaluation (RECIST) Evaluation (RECIST)
ResultsDrug delivery Assessment of drug delivery for GC and Paclitaxel sequences
ResultsTreatment efficacy Response Assessment to GC and Paclitaxel sequences • 8 responses of 11 achieved in locally advanced TCC without distant metastases • Responses achieved in locally advanced TCC without distant metastases (same patients)
Resultsfollow-up • Median response duration: 6 months • Median follow-up: 7 months - 21 patients died - 6 remained alive ---> 2 CR ---> 1 PR
Conclusion • Well tolerated regimen • ORR is in agreement with the results of previous regimens • Limited number of patients • Relatively short follow-up (7 months)