Case Report | FH-Deficient Uterine Leiomyomas: Pathological Insights into a Rare Tumor

Cisplatin-based chemotherapy is the standard first-line treatment for advanced urothelial carcinoma of the bladder. Many patients cannot receive cisplatin due to advanced age, renal insufficiency, and poor performance status. As an alternative, gemcitabine-carboplatin (GCa) is frequently used, yet the comparative efficacy of GCa vs. gemcitabine-cisplatin (GC) in real-world settings remains uncertain.

We conducted a retrospective analysis of 100 patients with advanced urothelial carcinoma who received either GC (n=60) or GCa (n=40) from January 2022 to December 2024. The primary endpoints were progression-free survival (PFS) and overall survival (OS). The secondary endpoints were objective response rate (ORR), disease control rate (DCR), and side effects of therapy. Kaplan-Meier methods were used to calculate survival curves.

The median PFS was 7.6 months (GC) vs 5.4 months (GCa) (p=0.03). The median OS was 13.8 months (GC) vs 10.1 months (GCa) (p=0.04). The ORR was higher in the GC group (GC, 42% versus GCa, 30%), but not statistically significant (p=0.08). Renal toxicity (grade 3/4) was higher in the GC group (18% vs 6%, p=0.02).

GC demonstrates improved efficacy compared to GCa in terms of PFS and OS, although this comes with renal toxicity. GCa can be a reasonable option for patients not receiving cisplatin.