Combination of Gemcitabine and Paclitaxel as Second-line Chemotherapy for Advanced Urothelial Carcinoma

Objective: The aim of this study was to evaluate the efficacy and toxicities of the gemcitabine and paclitaxel combination regimen as second-line chemotherapy for patients with advanced or metastatic urothelial carcinoma (UC) who have previously been treated with platinum-based chemotherapy for the metastatic disease. Methods: Thirty-three patients with advanced or metastatic UC who had received platinum-based chemotherapy were treated with an outpatient gemcitabine and paclitaxel combination regimen. A dose of 180 mg/m2 paclitaxel was administered by intravenous (IV) infusion on Day 1, and 1000 mg/m2 gemcitabine was administered by IV on Days 1, 8 and 15.The course was repeated every 28 days. Patients were evaluated after every 2 cycles of therapy using computed tomography. Results: Of the 33 patients enrolled in this study, 30 could be evaluated to determine treat-ment efficacy; 10 had an objective response [overall response rate: 33.3%, 95 % confidence interval (CI), 19.2–51.2%]. The median overall survival was 11.3 months (95 % CI, 7.2–13.6 months). The chemotherapy sensitivity differed with disease site. The response rates of lung and bone metastases were 27 % and 14%, and the progressive disease (PD) rates of lung and bone metastases were 13 % and 14%, respectively. On the other hand, the response rate of liver metastasis was 14%, and its PD rate was 57%. None of the patients (n 3) with adrenal metastasis responded to this regimen. Toxicities were mild, and no life-threatening complications occurred. Conclusions: Gemcitabine and paclitaxel combination therapy is a tolerable and active regimen for patients with advanced UC after failure of platinum-based chemotherapy. Key words: gemcitabine – paclitaxel – second-line chemotherapy – advanced urothelial carcinom