1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|