International Journal of Clinical Oncology

, Volume 20, Issue 2, pp 369–374 | Cite as

Carboplatin-based combination chemotherapy for elderly patients with advanced bladder cancer

  • Takahiro Yoneyama
  • Yuki Tobisawa
  • Tohru Yoneyama
  • Hayato Yamamoto
  • Atsushi Imai
  • Shingo Hatakeyama
  • Yasuhiro HashimotoEmail author
  • Takuya Koie
  • Chikara Ohyama
Original Article



We evaluated retrospectively the feasibility and effectiveness of carboplatin-based combination chemotherapy in elderly patients with advanced bladder cancer.


Forty-seven patients with advanced bladder cancer (33 men and 14 women) and treated at our hospital between August 2004 and December 2011 were enrolled. The average age was 77.1 years (range 70–86 years), the average creatinine clearance was 37.0 ml/min (range 14.5–113.0 ml/min), and the average follow-up period was 17.4 months (range 10–55 months). Twenty-nine patients (61.7 %) were unfit for cisplatin-based chemotherapy. There were 15 recurrent cases after radical surgery and 32 inoperable cases. In this study, the first-line therapy was gemcitabine and carboplatin (GCarbo), with two courses as a set. The second-line therapy was GCarbo and docetaxel (GCarboD) if there was an insufficient response to the first-line therapy.


Of the 47 patients who underwent GCarbo therapy, the response rate was 38.3 % (complete response plus partial response), with 5 and 13 patients exhibiting a complete response and a partial response, respectively. The average response duration was 15.7 months (range 2–42 months). The response rate of the nine patients who received GCarboD was 11.1 %, and the overall median survival was 15.0 months. Adverse events occurred in 30 patients (63.8 %) who underwent GCarbo therapy. Bone marrow suppression was observed in 30 patients (61.7 %), and digestive symptoms were observed in three patients (9.0 %).


Our study demonstrates that GCarbo is a safe and effective combination chemotherapy in elderly patients with advanced bladder cancer. However, the GCarboD regimen appears to have limited effectiveness for nonresponders to GCarbo therapy.


Advanced bladder cancer Elderly patients Carboplatin-based combination chemotherapy 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Stenzl A, Cowan NC, De Santis M et al (2009) The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 55(4):815–825CrossRefPubMedGoogle Scholar
  2. 2.
    Bellmunt J, Ribas A, Eres N et al (1997) Carboplatin-based versus cisplatin-based chemotherapy in the treatment of surgically incurable advanced bladder carcinoma. Cancer 80(10):1966–1972CrossRefPubMedGoogle Scholar
  3. 3.
    Bamias A, Moulopoulos LA, Koutras A et al (2006) 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 106(2):297–303CrossRefPubMedGoogle Scholar
  4. 4.
    De Santis M, Bellmunt J, Mead G et al (2012) Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986. J Clin Oncol 30(2):191–199CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Park JH, Lee SW, Kim HS et al (2013) Combination of gemcitabine and carboplatin as first line treatment in elderly patients or those unfit for cisplatin-based chemotherapy with advanced transitional cell carcinoma of the urinary tract. Cancer Chemother Pharmacol 71(4):1033–1039CrossRefPubMedGoogle Scholar
  6. 6.
    Sella A, Kovel S (2012) Combination of gemcitabine and carboplatin in urothelial cancer patients unfit for cisplatin due to impaired renal or cardiac function. Int Braz J Urol 38(1):49–56PubMedGoogle Scholar
  7. 7.
    Hoshi S, Ohyama C, Ono K et al (2004) Gemcitabine plus carboplatin; and gemcitabine, docetaxel, and carboplatin combined chemotherapy regimens in patients with metastatic urothelial carcinoma previously treated with a platinum-based regimen: preliminary report. Int J Clin Oncol 9(2):125–129CrossRefPubMedGoogle Scholar
  8. 8.
    Nogue-Aliguer M, Carles J, Arrivi A et al (2003) Gemcitabine and carboplatin in advanced transitional cell carcinoma of the urinary tract: an alternative therapy. Cancer 97(9):2180–2186CrossRefPubMedGoogle Scholar
  9. 9.
    Xu N, Zhang XC, Xiong JP et al (2007) A phase II trial of gemcitabine plus carboplatin in advanced transitional cell carcinoma of the urothelium. BMC Cancer 7:98CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Hoschke B, May M, Seehafer M et al (2004) Our experience with 23 consecutive patients on gemcitabine/carboplatin chemotherapy for treatment of metastasized transitional cell carcinoma of the urothelium. Int J Urol 11(7):461–466CrossRefPubMedGoogle Scholar
  11. 11.
    Linardou H, Aravantinos G, Efstathiou E et al (2004) Gemcitabine and carboplatin combination as first-line treatment in elderly patients and those unfit for cisplatin-based chemotherapy with advanced bladder carcinoma: phase II study of the Hellenic Co-operative Oncology Group. Urology 64(3):479–484CrossRefPubMedGoogle Scholar
  12. 12.
    McCaffrey JA, Hilton S, Mazumdar M et al (1997) Phase II trial of docetaxel in patients with advanced or metastatic transitional-cell carcinoma. J Clin Oncol 15(5):1853–1857PubMedGoogle Scholar
  13. 13.
    Tsuruta H, Inoue T, Narita S et al (2011) Combination therapy consisting of gemcitabine, carboplatin, and docetaxel as an active treatment for advanced urothelial carcinoma. Int J Clin Oncol 16(5):533–538CrossRefPubMedGoogle Scholar
  14. 14.
    Galsky MD, Hahn NM, Rosenberg J et al (2011) Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. J Clin Oncol 29(17):2432–2438CrossRefPubMedGoogle Scholar
  15. 15.
    Calvert AH, Newell DR, Gumbrell LA et al (1989) Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 7(11):1748–1756PubMedGoogle Scholar
  16. 16.
    Koie T, Ohyama C, Hashimoto Y et al (2013) Efficacies and safety of neoadjuvant gemcitabine plus carboplatin followed by immediate cystectomy in patients with muscle-invasive bladder cancer, including those unfit for cisplatin: a prospective single-arm study. Int J Clin Oncol 18(4):724–730CrossRefPubMedGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2014

Authors and Affiliations

  • Takahiro Yoneyama
    • 1
  • Yuki Tobisawa
    • 1
  • Tohru Yoneyama
    • 1
  • Hayato Yamamoto
    • 1
  • Atsushi Imai
    • 1
  • Shingo Hatakeyama
    • 1
  • Yasuhiro Hashimoto
    • 1
    Email author
  • Takuya Koie
    • 1
  • Chikara Ohyama
    • 1
  1. 1.Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan

Personalised recommendations