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Schinzari G, Rossi E, Pierconti F, Garufi G, Monterisi S, Strippoli A, D’Argento E, Cassano A, Barone C. Monoinstitutional real world experience in management of Vinflunine as second line therapy for transitional cell carcinoma of the urothelium. Oncotarget 2018; 9:8765-8771. [PMID: 29492236 PMCID: PMC5823567 DOI: 10.18632/oncotarget.24162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/03/2017] [Indexed: 11/25/2022] Open
Abstract
Vinflunine is the only cytotoxic agent tested as a second line therapy in transitional cell carcinoma of the urothelium in a phase III trial. It is not largely employed in clinical practice because of the high incidence of grade 3-4 toxicity. We evaluated efficacy and safety of Vinflunine at the dose of 280 mg/m2 every 3 weeks associated with primary prophylaxis with granulocyte growth factors and laxatives for patients progressed after platinum + Gemcitabine. Overall survival was 8.5 months, progression-free survival 4.33 months and response rate 25%, with disease control rate 57.2%. Grade III-IV neutropenia occurred in 10.7% of the patients, grade III-IV anemia and grade III thrombocytopenia in 10.7% and 7.2%, respectively. Among non haematological toxicity, grade I-II constipation was reported in 14.2% of the patients, without grade III-IV adverse events. No discontinuation for toxicity was observed. This study underlines that Vinfluinine at a dose of 280 mg/m2 associated with primary prophylaxis for neutropenia and constipation is effective and with a favorable toxicity profile.
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Affiliation(s)
- Giovanni Schinzari
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ernesto Rossi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giovanna Garufi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Santa Monterisi
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonia Strippoli
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ettore D’Argento
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Barone
- Department of Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
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Brousell SC, Fantony JJ, Van Noord MG, Harrison MR, Inman BA. Vinflunine for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract: an evidence-based review of safety, efficacy, and place in therapy. CORE EVIDENCE 2018; 13:1-12. [PMID: 29416444 PMCID: PMC5790085 DOI: 10.2147/ce.s118670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background A systematic review and meta-analysis of the use of systemic vinflunine (VIN) in the treatment of urothelial carcinoma (UC) was performed to evaluate its efficacy based on current available clinical data. Methods This review was prospectively registered at the International Prospective Register of Systematic Reviews, PROSPERO (registration CRD42016049294). Electronic databases including MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials, and Web of Science were searched through December 2016. We performed a meta-analysis of the published data. Primary end points were progression-free survival (PFS) and overall survival (OS). Numerous secondary clinical outcomes were analyzed including response and toxicity data. Results We identified 382 publications, of which 35 met inclusion criteria for this review representing 29 unique studies. A total of 2,255 patients received VIN for the treatment of UC in the included studies. OS and PFS were analyzed in a pooled Kaplan–Meier analysis. Response data were available for 1,416 VIN-treated patients with random effects proportion of complete response in 1%, partial response in 18%, and overall response rate of 21%. Toxicity analysis revealed fatigue (40.1%), nausea (33.9%), constipation (34.1%), and alopecia (26.0%) as the most prevalent overall non-hematologic adverse events (AEs). Most prevalent grade 3–4 AEs were fatigue (10.2%), abdominal pain (8.2%), myalgias (2.5%), and nausea (2.3%). Most common hematologic AEs of all grades were anemia (56.6%), neutropenia (46.0%), thrombocytopenia (25.5%), and febrile neutropenia (6.6%). Grade 3–4 hematologic AEs had the following pooled rates: neutropenia, 24.6%; anemia, 10.2%; febrile neutropenia, 5.4%; and thrombocytopenia, 3.0%. Conclusion VIN has been explored as a combination first-line treatment as well as a single-agent second-line, third-line, and maintenance therapy for advanced and metastatic UC. In first-line treatment of UC, either as a maintenance agent after cisplatin or as a primary combination therapy, VIN may be a promising alternative to current treatments. Further studies are needed to compare first-line combination VIN regimens to the current standard of care in order to assess long-term survival outcomes. Second- and third-line VIN monotherapy does provide a proven, although limited, survival benefit in platinum-refractory patients.
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Affiliation(s)
| | | | | | - Michael R Harrison
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
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Passalacqua R, Lazzarelli S, Donini M, Montironi R, Tambaro R, De Giorgi U, Pignata S, Palumbo R, Ceresoli GL, Del Conte G, Tonini G, Morelli F, Nolè F, Panni S, Rondini E, Guida A, Zucali PA, Doni L, Iezzi E, Caminiti C. Real-life clinical practice results with vinflunine in patients with relapsed platinum-treated metastatic urothelial carcinoma: an Italian multicenter study (MOVIE-GOIRC 01-2014). BMC Cancer 2017; 17:493. [PMID: 28724419 PMCID: PMC5517798 DOI: 10.1186/s12885-017-3466-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/30/2017] [Indexed: 01/06/2023] Open
Abstract
Background Vinflunine is the only chemotherapeutic agent shown to improve survival in platinum-refractory patients with metastatic transitional cell carcinoma of the urothelium (TCCU) in a phase III clinical trial, which led to product registration for this indication in Europe. The aim of this study was to assess the efficacy of vinflunine and to evaluate the prognostic significance of risk factors in a large, unselected cohort of patients with metastatic TCCU treated according to routine clinical practice. Methods This was a retrospective multicenter study. Italian cancer centers were selected if, according to the Registry of the Italian Medicines Agency (AIFA), at least four patients had been treated with vinflunine between February 2011 and June 2014, after first- or second-line platinum-based chemotherapy. The primary objective was to test whether the efficacy measured by overall survival (OS) in the registration study could be confirmed in routine clinical practice. Multivariate analysis was carried out using Cox proportional hazard model. Results A total of 217 patients were treated in 28 Italian centers. Median age was 69 years (IQR 62–76) and 84% were male; Eastern Cooperative Oncology Group performance status (ECOG PS) was ≥ 1 in 53% of patients. The median number of cycles was 4 (IQR 2–6); 29%, 35%, and 36% received an initial dose of 320 mg/m2, 280 mg/m2 or a lower dose, respectively. Median progression-free survival (PFS) and OS for the entire population was 3.2 months (2.6–3.7) and 8.1 months (6.3–8.9). A complete response was observed in six patients, partial response in 21, stable disease in 60, progressive disease in 108, with a disease control rate of 40%. Multivariate analysis showed that ECOG PS, number of metastatic sites and liver involvement were unfavorable prognostic factors for OS. Toxicity was mild, and grade 3–4 adverse effects were mainly: neutropenia (9%), anemia (6%), asthenia/fatigue (7%) and constipation (5%). Conclusions In routine clinical practice the results obtained with VFL seem to be better than the results of the registration trial and reinforce evidence supporting its use after failure of a platinum-based chemotherapy. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3466-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Silvia Lazzarelli
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Maddalena Donini
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Rosa Tambaro
- Department of Urogynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - Ugo De Giorgi
- Oncologia Genitourinaria, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Department of Urogynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | | | | | | | - Giuseppe Tonini
- Dipartimento di Oncologia, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Franco Morelli
- Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Franco Nolè
- Oncologia, Istituto Europeo di Oncologia, Milan, Italy
| | - Stefano Panni
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Ermanno Rondini
- Oncologia, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Annalisa Guida
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Laura Doni
- Oncologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Elisa Iezzi
- Ricerca e Innovazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Caterina Caminiti
- Ricerca e Innovazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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