Prospective Trial of Ifosfamide, Paclitaxel, and Cisplatin in Patients with Advanced Non-transitional Cell Carcinoma of the Urothelial Tract
Cornell University, Итак, New York, United States Urology
(Impact Factor: 2.19).
03/2007; 69(2):255-9. DOI: 10.1016/j.urology.2006.10.029
Non-transitional cell carcinomas account for 5% to 10% of urothelial tract tumors and are each characterized by unique demographics, risk factors, and patterns of spread. A unifying feature of these malignancies is their aggressive course and poor outcome with standard chemotherapeutic regimens. Given the rarity of these tumors, no prospective data are available to guide management.
Patients with unresectable/metastatic adenocarcinoma or squamous cell, small cell, sarcomatoid, or poorly differentiated carcinoma of the urothelial tract were eligible for enrollment. Treatment consisted of paclitaxel 200 mg/m2 intravenously on day 1, cisplatin 70 mg/m2 intravenously on day 1, ifosfamide 1500 mg/m2 intravenously on days 1 to 3 plus mesna. Granulocyte colony-stimulating factor was administered with each cycle. The treatment was started again every 3 to 4 weeks for a maximum of six cycles.
A total of 20 patients were enrolled. They had the following histologic types: adenocarcinoma in 11, squamous cell carcinoma in 8, and small cell carcinoma in 1. Patients received a median of four cycles (range one to six). The treatment was generally well tolerated, and the toxicity was predominantly hematologic. Overall, 7 (35%) of 20 patients (95% confidence interval 15% to 59%) achieved a major response (3 partial and 4 complete). The median survival for patients with adenocarcinoma was 24.8 months (95% confidence interval 10.2 to 32.3), and for those with squamous cell carcinoma it was 8.9 months (95% confidence interval 5.4 to not yet reached).
The results of our study have shown that this regimen (ifosfamide, paclitaxel, and cisplatin) is active in patients with advanced non-transitional cell carcinoma of the urothelial tract. To our knowledge, this is the first prospective study of a chemotherapeutic regimen in this patient population.
Available from: Scott T Tagawa
- "Treatment of clinically localized disease is usually surgical since these tumors may be resistant to chemotherapy and radiation, similar to squamous cell carcinomas of other sites . Chemotherapeutic regimens for urothelial carcinoma are sometimes used but with variable results  , though chemotherapy for nonbilharzial SCC is under-studied. Prognosis for patients with SCC of the bladder is poor, and most die from their disease within 1–3 years of diagnosis. "
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ABSTRACT: We report an unusual case of a 78-year-old Caucasian female, who presented with peritoneal carcinomatosis and hypercalcemia, and was found to have a rapidly progressive primary squamous cell carcinoma of the urinary bladder. Squamous cell bladder carcinoma is a rare malignancy in the United States, accounting for just 1-3% of bladder tumors. Interestingly our patient lacked the established risk factors, including exposure to the parasite Schistosoma haematobium, recurrent urinary tract infections, bladder calculi, radiation exposure, chronic indwelling catheter, neurogenic bladder, or tobacco abuse. Although hypercalcemia has been rarely described, an initial presentation of peritioneal carcinomatosis has not been previously reported.
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ABSTRACT: Non-transitional cell carcinomas of the urothelial tract comprise 5–10% of urothelial cancers. Clinical information regarding
the clinical behavior and chemotherapy outcome of non-transitional cell carcinomas of the urothelial tract are incomplete
due to their rarity. The object of this study was to evaluate the clinical features and the efficacy of palliative chemotherapy
in advanced non-transitional cell carcinomas of the urothelial tract. We analyzed the clinical records of 21 consecutive patients
who received palliative chemotherapy for unresectable or metastatic non-transitional cell carcinomas of the urothelial tract
between January 1995 and November 2007. All the 21 patients received first-line chemotherapy with platinum-based regimens
which are known to be effective in transitional cell urothelial carcinomas. The median age of the patients was 57years (range,
27–71years). The primary sites of involvement were the bladder, urethra, urachus, and ureter in 43%, 29%, 19%, and 10% of
the patients, respectively. Adenocarcinoma was the most common histological type (67%); squamous cell carcinoma and small
cell carcinoma comprised 24 and 10% of the histologic types, respectively. With a median duration of follow-up of 32months
(range, 12–71months), the median overall survival for all 21 patients from the day of first-line chemotherapy was 13months
(95% CI, 6.8–19.2). The expected 1-year survival rate was 50.6% (95% CI, 28.6–72.5). Univariate analysis showed a better median
overall survival in patients with adenocarcinoma, compared to non-adenocarcinomas (47 vs. 10months, P=0.049). The median overall survival of patients who received platinum-based palliative chemotherapy for advanced non-transitional
cell carcinomas was comparable to previous studies for patients with transitional cell carcinomas. Adenocarcinomas appear
to have a favorable prognosis for the survival of the patients who received platinum-based chemotherapy for advanced non-transitional
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ABSTRACT: Pure urothelial carcinoma makes up 90-95% of all bladder cancer. The remaining 5-10% represent urothelial carcinoma with aberrant differentiation patterns and nonurothelial carcinoma. Reviews on this topic often focus on the pathological features of these histologic subtypes. In this review we have summarized the clinical significance of each major histologic pattern and analyzed the response of each to standard treatment modalities. The main limitation to optimizing management is the inability to perform clinical trials owing to the rarity of these tumors. This can be circumvented to some degree by extrapolating knowledge acquired from more common similar tumors in other organ sites. Ultimately, however, multicenter clinical trials will need to be organized to address some key management issues.
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