Cisplatin and gemcitabine versus carboplatin and gemcitabine in metastatic bladder cancer: Survival analysis of veterans' health care data.

Abstract

e16023 Background: Background: Cisplatin and gemcitabine combination chemotherapy is the standard regimen used for the treatment of metastatic bladder cancer. Most Veterans Administration (VA) patients with metastatic bladder cancer are elderly or with poor renal function, and are considered not good candidates for cisplatin administration. It is a common practice to substitute carboplatin for cisplatin in this population. Methods: Methods: We identified stage IV bladder cancer patients treated initially with cisplatin plus gemcitabine (Ci+G) or carboplatin plus gemcitabine (Ca+G) at VA medical centers from 2000 to 2010. The data was obtained via the VA central cancer registry from all VA medical centers across the country. Overall survival (OS) was summarized as Kaplan-Meier medians and compared for difference between platinum groups via Cox regression. Results: Results: 196 subjects () with stage IV bladder cancer were identified. There were 194 males , 78 received Ca+G, 118 received Ci+G. 149 deaths occurred during 197.49 person-years of follow up, for a median OS of 10.35 months. Median OS was 11.14 months with Ca+G versus 10.35 months with Ci+G. Cox regression revealed nearly equal group mortality rates, with Ca+G having a hazard ratio (90% confidence limits) of 1.02 (0.77–1.34) compared to Ci+G ( P= 0.93). Conclusions: Conclusion: Patients treated with Ca+G and Ci+G regimens had similar median OS, supporting the substitution of carboplatin for cisplatin with gemcitabine in this patient population.