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Erstlinienchemotherapie beim Harnblasenkarzinom
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De Santis, Maria , Albers, P. and Bokemeyer, C. (2012) Erstlinienchemotherapie beim Harnblasenkarzinom. Der Onkologe, Volume 18 (Number 11). pp. 1012-1017. doi:10.1007/s00761-012-2325-8 ISSN 0947-8965.
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Official URL: http://dx.doi.org/10.1007/s00761-012-2325-8
Abstract
The incidence of bladder cancer in Europe was estimated to be 133,700 cases in 2008 (104,600 males and 29,100 females) corresponding to 6.2 % of tumors in men and 1.9 % in women. The incidence of these tumors has therefore not substantially changed in 5 years (WHO Globocan project 2008). Cisplatin-containing combination chemotherapy has been the standard of care in the treatment of urothelial cancer (UC) since the late 1980s. Gemcitabine/cisplatin, MVAC, high-dose MVAC and the new triplet paclitaxel/cisplatin/gemcitabine are possible treatment options with different toxicity profiles. However, up to 50% of patients are unfit for cisplatin-containing chemotherapy, either due to a poor performance status (PS) and/or impaired renal function or due to co-morbidities that prevent high-volume hydration. These conditions increase with age. There is controversy about the definition of fit or unfit for cisplatin therapy. An international survey revealed five factors to be crucial: decreased PS, renal function impairment, peripheral neuropathy, hearing loss and heart failure. A standard chemotherapy has not yet been established for patients ineligible for cisplatin-based standard chemotherapy. Trials with clearly defined unfit patients or patients with multiple adverse prognostic factors are rare. The first randomized phase II/III trial in this setting compared carboplatin/vinblastin/methotrexate (M-CAVI) and carboplatin/gemcitabine (CG) in patients unfit for cisplatin. Overall survival (OS) was not statistically significantly different between the two treatment regimens with a median OS of 9.3 and 8.1 months for CG and M-CAVI, respectively. Severe acute toxicity was higher for the M-CAVI arm and therefore carboplatin/gemcitabine is the preferred treatment option in cisplatin ineligible patients.
Item Type: | Journal Article | ||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Cancer Research Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Der Onkologe | ||||
Publisher: | Springer | ||||
ISSN: | 0947-8965 | ||||
Official Date: | 2012 | ||||
Dates: |
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Volume: | Volume 18 | ||||
Number: | Number 11 | ||||
Page Range: | pp. 1012-1017 | ||||
DOI: | 10.1007/s00761-012-2325-8 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access |
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