Intermittent chemotherapy is a treatment choice for advanced urothelial cancer

To investigate the potential benefit of intermittent chemotherapy, and to identify the eligibility criteria offering intermittent chemotherapy to patients with advanced urothelial cancer.

Twenty patients who responded or had stable disease after receiving 3 cycles of induction chemotherapy (gemcitabine and cisplatin, or paclitaxel and carboplatin) were enrolled for a prospective study of intermittent chemotherapy. We evaluated for the duration of chemotherapy holiday, toxicity, quality of life (QOL), and overall survival.

The median number of cycles was 7 (range, 3-25). On resumption of treatment after the first chemotherapy holiday, 65% of the patients had partial response, 25% had stable disease, and 10% of the patients developed disease progression. The median duration of chemotherapy holiday was 22 weeks (range, 4-94), and the median chemotherapy holiday rate (CHR) was 0.53 (range, 0.25-0.86). The duration of the first chemotherapy holiday of more than 8 weeks significantly correlated to a high CHR. A response to induction chemotherapy, and normal levels of albumin and hemoglobin significantly correlated with a higher CHR. A significant improvement in fatigue, nausea and vomiting, and appetite loss was seen in the symptom scales of QLQ-C30 during the chemotherapy holiday.

Intermittent chemotherapy is a feasible treatment strategy to balance disease control and QOL in selected patients.