HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Cote G, Alqaisi HA, Sridhar SS, et al.

Kidney and Cancer Outcomes with Standard vs. Kidney Protective Chemotherapy Regimens for First-Line Treatment of Metastatic Urothelial Carcinoma

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:10A 2020


Cisplatin-based combination chemotherapy regimen is the optimal initial treatment for metastatic urothelial carcinoma, but kidney function eligibility and nephrotoxicity are treatment-limiting for many patients. For patients unfit to receive cisplatin, other options include alternative administration schedules (e.g. split dose cisplatin), carboplatin -based regimens and non-platinum regimens. The aims of this study were to compare cancer outcomes and incidence of acute kidney injury (AKI) during treatment among 3 regimens of chemotherapy.


We conducted a single-center retrospective study of patients receiving first- line chemotherapy for metastatic urothelial carcinoma (2005-2019). We compared standard gemcitabine-cisplatin (gem-cis) to: 1) gemcitabine- cisplatin split dose regimen (split) with cisplatin divided over day 1 and 8; and 2) combination of gemcitabine-carboplatin or single-agent gemcitabine (gem/gem-carbo). We used Fine and Gray hazard models accounting for baseline covariates and competing risk of death.


We identified 183 patients (98 gem-cis, 32 split and 53 gem/gem-carbo). Median age was 67 years-old (IQR: 61-73) and 76% were male. Median baseline eGFR was 78 mL/min/1.73m2 (IQR: 66-91) in gem-cis, 64 (48-77) in split, and 45 (33-57) in gem/gem-carbo. Patients receiving split and gem/gem-carbo were older, had worse performance status, and hypertension was more frequent. Split and gem/gem-carbo regimens were associated with higher mortality and progressive disease relative to gem-cis when adjusted for age, baseline eGFR, ECOG, hypertension and diabetes with hazard ratio (HR) of 1.56 (95%CI: 1.04- 2.34; p=0.03) and 2.02 (95%CI: 1.36-3.01; p<0.01) respectively. Median time to progressive disease was 242 (IQR: 137-444), 182 (122-279) and 131 (68 -257) days in gem-cis, split and gem/gem-carbo groups. There was no significant association between regimen type and AKI with HR of 1.32 (95%CI: 0.62-2.81; p=0.47) and 0.98 (95%CI:0.46-2.09; p=0.96) for split and gem/gem- carbo groups versus gem-cis.


Kidney protective chemotherapy regimens were associated with increased disease progression and mortality, without a significant difference in AKI. Alternative kidney protective strategies are needed for patients with CKD and urothelial cancer.

c Copyright 2020 -2021 American Society of Nephrology. Reproduced with permission.
All ASN abstracts from the 2020 Annual Meeting are available at this link and also are archived in .pdf form at ASN-Online.org

Disclaimer: Abstracts often have errors, both typographical and otherwise. This posting is an electronic translation of submitted abstracts which has not been verified against the original submitted abstract nor with the authors for accuracy. As a result, there may be errors, especially with regard to drug doses, but not limited to these. Abstracts undergo only limited review, and data often are changed as a result of the peer review process, so their reliability is less than manuscripts published in peer-reviewed journals. In using these summaries, you are agreeing that you are aware of these limitations.

The materials are provided on an as-is basis without any warranty of any kind, either express or implied. In addition to errors, the information presented may be incomplete or outdated. The information contained is not intended nor recommended as a substitute for professional medical advice. You are advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device to be used or drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug, disease, and the best treatment for the patient.

To the fullest extent permitted by law, HDCN, ASN and their affiliates and suppliers disclaim all warranties, express or implied, including, but not limited to, any warranty of merchantability, non- infringement or fitness for a particular purpose.

In no event shall HDCN, ASN, or their affiliates or suppliers be liable for any damages whatsoever (including, but not limited to, direct, indirect, incidental, consequential, punitive or exemplary damages, or any damages for loss of profits, use, data, goodwill or other intangibles) arising from or in any way relating to these terms, the materials, or any information, goods or services obtained from or referred to in the materials, whether based on warranty, contract, tort (including, but not limited to, negligence), or any other legal theory, and whether or not any or all of the limited entities is advised of the possibility of such damages.