Objective: The objective of this retrospective study was to investigate the efficacy and safety of vinflunine monotherapy and the utility of second-line prognostic factors in patients with advanced or metastatic urothelial cancer relapsing/progressing during or after a prior platinum-containing regimen under daily routine clinical conditions in Germany. Methods: The selection was based on the marketing authorization indication and recommendations as well as on the evaluation of second-line prognostic factors issued from prior pivotal trials. Results: Eight centers across Germany provided a total of 21 patient records. Demographic and clinical characteristics were similar to the data previously reported in pivotal trials. Complete and partial response to vinflunine treatment was observed in 1 (4.8%) and 3 (14.3%) patients, respectively, resulting in an overall response rate of 19.1%. The disease control rate reached 47.7%. The median progression-free survival amounted to 4.4 months (95% CI 2.6-6.6), with a median overall survival of 6.2 months (95% CI 3.9-10.7). The observed toxicity profile was manageable and consistent with prior clinical trials: leukopenia (33.3%), neutropenia (9.5%), anemia (9.5%) and hyperglycemia (4.8%). The reported satisfaction rate with the treatment was 90.5 and 61.9% among patients and physicians, respectively. Conclusions: This retrospective study confirms that the clinical outcomes obtained from routine medical practice in Germany with vinflunine in the treatment of advanced/metastatic urothelial cancer are in line with the data observed in prior clinical trials.

1.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-2917.
2.
Boyle P, Ferlay J: Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005;16:481-488.
3.
Donat M, Herr H: Transitional cell carcinoma of the renal pelvis and ureter: diagnosis, staging, management, and prognosis; in Osterling JE, Richie JP (eds): Urologic Oncology. Philadelphia, WB Saunders Harcourt Brace & Co, 1997.
4.
Sternberg CN, Yagoda A, Scher HI, Watson RC, Herr HW, Morse MJ, Sogani PC, Vaughan ED Jr, Bander N, Weiselberg LR, et al: M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for advanced transitional cell carcinoma of the urothelium. J Urol 1988;139:461-469.
5.
Sternberg CN: Second-line treatment of advanced transitional cell carcinoma of the urothelial tract. Curr Opin Urol 2001;11:523-529.
6.
Zeegers MP, Goldbohm RA, van den Brandt PA: A prospective study on active and environmental tobacco smoking and bladder cancer risk (The Netherlands). Cancer Causes Control 2002;13:83-90.
7.
von der Maase H, Sengelov L, Roberts JT, Ricci S, Dogliotti L, Oliver T, Moore MJ, Zimmermann A, Arning M: Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 2005;23:4602-4608.
8.
von der Maase H, Hansen SW, Roberts JT, Dogliotti L, Oliver T, Moore MJ, Bodrogi I, Albers P, Knuth A, Lippert CM, Kerbrat P, Sanchez Rovira P, Wersall P, Cleall SP, Roychowdhury DF, Tomlin I, Visseren-Grul CM, Conte PF: Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000;18:3068-3077.
9.
Cohen MH, Rothmann M: Gemcitabine and cisplatin for advanced, metastatic bladder cancer. J Clin Oncol 2001;19:1229-1231.
10.
Stenzl A, Witjes JA, Compérat E, Cowan NC, De Santis M, Kuczyk MA, Lebret T, Ribal MJ, Sherif A: The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. http://www.uroweb.org/guidelines/online-guidelines/ (accessed October 17, 2012).
11.
Galsky MD, Hahn NM, Rosenberg J, Sonpavde G, Hutson T, Oh WK, Dreicer R, Vogelzang N, Sternberg CN, Bajorin DF, Bellmunt J: Treatment of patients with metastatic urothelial cancer ‘unfit' for cisplatin-based chemotherapy. J Clin Oncol 2011;29:2432-2438.
12.
De Santis M, Bellmunt J, Mead G, Kerst JM, Leahy M, Maroto P, Skoneczna I, Marreaud S, de Wit R, Sylvester R: Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer ‘unfit' for cisplatin-based chemotherapy: phase II - results of EORTC study 30986. J Clin Oncol 2009;27:5634-5639.
13.
Lorusso V, Pollera CF, Antimi M, Luporini G, Gridelli C, Frassineti GL, Oliva C, Pacini M, De Lena M: A phase II study of gemcitabine in patients with transitional cell carcinoma of the urinary tract previously treated with platinum. Italian Co-operative Group on Bladder Cancer. Eur J Cancer 1998;34:1208-1212.
14.
Costantini C, Millard F: Update on chemotherapy in the treatment of urothelial carcinoma. Sci World J 2011;11:1981-1994.
15.
Lei AQ, Cheng L, Pan CX: Current treatment of metastatic bladder cancer and future directions. Expert Rev Anticancer Ther 2011;11:1851-1862.
16.
Serrano C, Morales R, Suarez C, Nunez I, Valverde C, Rodon J, Humbert J, Padros O, Carles J: Emerging therapies for urothelial cancer. Cancer Treat Rev 2012;38:311-317.
17.
Bellmunt J, Choueiri TK, Fougeray R, Schutz FA, Salhi Y, Winquist E, Culine S, von der Maase H, Vaughn DJ, Rosenberg JE: Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol 2010;28:1850-1855.
18.
Albers P, Park SI, Niegisch G, Fechner G, Steiner U, Lehmann J, Heimbach D, Heidenreich A, Fimmers R, Siener R; AUO Bladder Cancer Group: Randomized phase III trial of 2nd line gemcitabine and paclitaxel chemotherapy in patients with advanced bladder cancer: short-term versus prolonged treatment [German Association of Urological Oncology (AUO) trial AB 20/99]. Ann Oncol 2011;22:288-294.
19.
Jordan MA, Horwitz SB, Lobert S, Correia JJ: Exploring the mechanisms of action of the novel microtubule inhibitor vinflunine. Semin Oncol 2008;35(suppl 3):S6-S12.
20.
Kruczynski A, Hill BT: Vinflunine, the latest vinca alkaloid in clinical development. A review of its preclinical anticancer properties. Crit Rev Oncol Hematol 2001;40:159-173.
21.
Kruczynski A, Etievant C, Perrin D, Chansard N, Duflos A, Hill BT: Characterization of cell death induced by vinflunine, the most recent vinca alkaloid in clinical development. Br J Cancer 2002;86:143-150.
22.
Kruczynski A, Barret JM, Etievant C, Colpaert F, Fahy J, Hill BT: Antimitotic and tubulin-interacting properties of vinflunine, a novel fluorinated vinca alkaloid. Biochem Pharmacol 1998;55:635-648.
23.
Bonfil RD, Russo DM, Binda MM, Delgado FM, Vincenti M: Higher antitumor activity of vinflunine than vinorelbine against an orthotopic murine model of transitional cell carcinoma of the bladder. Urol Oncol 2002;7:159-166.
24.
Hill BT, Fiebig HH, Waud WR, Poupon MF, Colpaert F, Kruczynski A: Superior in vivo experimental antitumour activity of vinflunine, relative to vinorelbine, in a panel of human tumour xenografts. Eur J Cancer 1999;35:512-520.
25.
Culine S, Theodore C, De Santis M, Bui B, Demkow T, Lorenz J, Rolland F, Delgado FM, Longerey B, James N: A phase II study of vinflunine in bladder cancer patients progressing after first-line platinum-containing regimen. Br J Cancer 2006;94:1395-1401.
26.
Vaughn DJ, Srinivas S, Stadler WM, Pili R, Petrylak D, Sternberg CN, Smith DC, Ringuette S, de Wit E, Pautret V, George C: Vinflunine in platinum-pretreated patients with locally advanced or metastatic urothelial carcinoma - results of a large phase 2 study. Cancer 2009;115:4110-4117.
27.
Médicament PF: Javlor® summary of product characteristics. June 2012.
28.
Bellmunt J, Theodore C, Demkov T, Komyakov B, Sengelov L, Daugaard G, Caty A, Carles J, Jagiello-Gruszfeld A, Karyakin O, Delgado FM, Hurteloup P, Winquist E, Morsli N, Salhi Y, Culine S, von der Maase H: Phase III trial of vinflunine plus best supportive care compared with best supportive care alone after a platinum-containing regimen in patients with advanced transitional cell carcinoma of the urothelial tract. J Clin Oncol 2009;27:4454-4461.
29.
Bellmunt J, Orsola A, Wiegel T, Guix M, De Santis M, Kataja V: Bladder cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011;22:vi45-vi49.
30.
Otto T: Drug Report Vinflunin. Stuttgart, Thieme, 2010.
31.
Bamias A, Moulopoulos LA, Koutras A, Aravantinos G, Fountzilas G, Pectasides D, Kastritis E, Gika D, Skarlos D, Linardou H, Kalofonos HP, Dimopoulos MA: The combination of gemcitabine and carboplatin as first-line treatment in patients with advanced urothelial carcinoma. A phase II study of the Hellenic Cooperative Oncology Group. Cancer 2006;106:297-303.
32.
Bellmunt J, de Wit R, Albanell J, Baselga J: A feasibility study of carboplatin with fixed dose of gemcitabine in ‘unfit' patients with advanced bladder cancer. Eur J Cancer 2001;37:2212-2215.
33.
Biswas B, Sahoo R, Kumar L, Mohanti B, Seth A: Muscle invasive urinary bladder cancer: response to neoadjuvant chemotherapy is predictor of improved progression free survival. Ann Oncol 2012;23(suppl 9):ix264.
34.
Maughan B, Boucher K, Agarwal N: Correlation of progression-free survival at 6 months (PFS6) with overall survival at 12 months (OS12) in an analysis of 10 trials of second-line therapy for advanced urothelial carcinoma (UC). J Clin Oncol 2012;30:Abstr 4525.
35.
Pond R, Sonpavde G, Choueiri T: Time from prior chemotherapy (TFPC) as a prognostic factor in advanced urothelial carcinoma (UC) receiving second-line systemic therapy. J Clin Oncol 2012;30:Abstr 4522.
36.
Sonpavde G, Pond G, Choueriri T: Prognostic stratification of advanced urothelial carcinoma (UC) receiving second-line systemic therapy including time from prior chemotherapy (TFPC) as a prognostic factor. Ann Oncol 2012;23(suppl 9):ix265.
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