Predictive factors of response to cisplatin-based chemotherapy and the relation of response to survival in patients with metastatic urothelial cancer

Purpose: To identify pretreatment variables predicting overall and complete response to cisplatin-based chemotherapy for metastatic urothelial cancer, and to study the relation between response and the duration of survival. P atients and methods: A total of 119 evaluable patients with recurrent local ly advanced or metastatic urothelial cancer received cisplatin-based combin ation chemotherapy in four consecutive phase II studies from 1987 to 1997. The relationship of pre treatment variables and response was evaluated with logistic regression, and prognostic factors for survival were analyzed wit h Cox's multivariate model. Results: Response was achieved in 49% of the pa tients with a complete response rate of 15%. Good performance status and ab sence of bone metastases were independently predictive of overall response. Good performance status and normal hemoglobin were independently predictiv e of complete response. Median survival was 8.9 months. Performance status, alkaline phosphatase, s-creatinine, liver and bone metastases were indepen dent prognostic factors for survival. Median survival was 12.4 months in re sponding patients and 6.3 in nonresponding patients. Response to chemothera py was included in the multivariate model and was the strongest prognostic factor for survival. Conclusion: The presence of bone metastases, low hemog lobin or poor performance status predicts decreased chance of response to c hemotherapy. Response to chemotherapy is an independent prognostic factor f or prolonged survival in patients with metastatic urothelial cancer.