Efficacy of Different Second-line Therapy Regimens in Metastatic Urothelial Carcinoma

Abstract

Introduction: Metastatic Urothelial Cancer (UC) has a reported survival from platinum based chemotherapy of 15 months. Second line chemotherapy is considered relatively ineffective. Recently, new immuno-oncology drugs have been introduced. Objectives: Aim of this study was to analyze the survival by regimen and metastatic sites of second line treatment for UC. Methods: We analysed 70 patient receiving second line therapy between January 2010 and December 2016 at Heidelberg University Hospital. Median age was 60.9 years, male to female distribution was 74,3% to 25,7%. Regimens used were vinflunine (n=40, 57,1%) taxane based (n=20, 28,6%) and immunotherapy (n=9, 12,9%). Results: Median overall survival (OS) from first line therapy over all lines was 28,0 months. Median OS from second line was 14,7 months (95% CI, 11,4-18,0). No significant differences between regimens could be detected. OS of patients with lymphonodal only involvement (n=16, 22,5%) was 35.5 months (95% CI 0.0-73.9), OS with visceral metastases excluding liver was 14.7 months (95% CI 9.8-19.6) .and OS with any liver involvement was 9.4 months (95% CI 0.0-20.9). Conclusion: Second line therapy for UC of selected patients leads to a prolonged survival compared to historical data. The choice of regimen appears not to influence OS. Lymphnodal only involvement is associated with the best prognosis.