Adverse Events Associated with GC Therapy for Urothelial Cancer

Purpose: The standard care for chemotherapy in urothelial cancer is now shifting from conventional M-VAC to GC therapies. The GC therapy is associated with milder adverse events but more often leads to discontinued Day 8 or 15 treatment with gemcitabine due to adverse events compared to M-VAC therapy. There are few detailed reports on the criteria for treatment discontinuation and dose reduction in GC therapy. Thus, we report a study on adverse events associated with GC therapy. Methods: We retrospectively investigated the patient characteristics, doses, adverse events until the third course, and status of Day 8 and 15 treatments in patients with urothelial cancer who received GC therapy in the urology department of our hospital between September 2009 and November 2011. Results: Thirty-five subjects were enrolled; at the start of therapy, a full dose was administered in twenty-nine patients and a reduced dose in six patients. Among the twenty-nine patients who received full-dose therapy, fifteen (52%) showed grade 3-4 hematotoxicity in the first course of therapy. Sixteen patients could continue the therapy until the third course, of whom fourteen (87%) showed Grade 3-4 hematotoxicity. Twenty-five (86%) discontinued either Day 8 or 15 treatment due to adverse events. Discussion: The onset rate of hematotoxicity was significantly higher in the third compared to the first course (p-value: 0.007), suggesting that we should pay attention to hematotoxicity in the third and later courses of therapy, irrespective of the absence of hematotoxicity in the first course.