Cisplatin-based chemotherapy followed by radical cystectomy (RC) is recommended in patients with muscle-invasive bladder cancer (MIBC). However, up to 50% of patients are cisplatin ineligible. The aim of this study was to compare clinical outcomes after ≥ 3 cycles of preoperative gemcitabine-carboplatin (gem-carbo) versus gemcitabine-cisplatin (gem-cis).
We identified 1865 patients treated at 19 centers between 2000 and 2013. Patients were included if they had received ≥ 3 cycles of neoadjuvant (cT2-4aN0M0) or induction (cTanyN + M0) gem-carbo or gem-cis followed by RC.
We included 747 patients treated with gem-carbo (n = 147) or gem-cis (n = 600). Patients treated with gem-carbo had a higher Charlson Comorbidity Index (p = 0.016) and more clinically node-positive disease (32% versus 20%; p = 0.013). The complete pathological response (pCR; ypT0N0) rate did not significantly differ between gem-carbo and gem-cis (20.7% versus 22.1%; p = 0.73). Chemotherapeutic regimen was not significantly associated with pCR (OR 0.99 [95%CI 0.61-1.59]; p = 0.96), overall survival (OS) (HR 1.20 [95%CI 0.85-1.67]; p = 0.31), or cancer-specific survival (CSS) (HR 1.35 [95%CI 0.93-1.96]; p = 0.11). Median OS of patients treated with gem-carbo and gem-cis was 28.6 months (95%CI 18.1-39.1) and 45.1 months (95%CI 32.7-57.6) (p = 0.18), respectively. Median CSS of patients treated with gem-carbo and gem-cis was 28.8 months (95%CI 9.8-47.8) and 71.0 months (95%CI median not reached) (p = 0.02), respectively. Subanalyses of the neoadjuvant and induction setting did not show significant survival differences.
Our results show that a subset of cisplatin-ineligible patients with MIBC achieve pCR on gem-carbo and that survival outcomes seem comparable to gem-cis provided patients are able to receive ≥ 3 cycles and undergo RC.
World journal of urology. 2022 Sep 28 [Epub ahead of print]
Sarah M H Einerhand, Anna J Black, Homayoun Zargar, Adrian S Fairey, Colin P Dinney, Maria C Mir, Laura-Maria Krabbe, Michael S Cookson, Niels-Erik Jacobson, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Wassim Kassouf, Marc A Dall'Era, Srikala S Sridhar, Jonathan S McGrath, Jonathan Aning, Shahrokh F Shariat, Jonathan L Wright, Andrew C Thorpe, Todd M Morgan, Jeff M Holzbeierlein, Trinity J Bivalacqua, Scott North, Daniel A Barocas, Yair Lotan, Petros Grivas, Jorge A Garcia, Andrew J Stephenson, Jay B Shah, Siamak Daneshmand, Kamran Zargar-Shoshtari, Philippe E Spiess, Bas W G van Rhijn, Peter C Black, Laura S Mertens
Department of Surgical Oncology (Urology), The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands., Vancouver Prostate Centre, Vancouver, Canada., Department of Urology, Western Health, Melbourne, Australia., USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA., Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain., Department of Urology, University of Münster, Münster, Germany., Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA., University of Alberta, Edmonton, AB, Canada., Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA., Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK., Division of Oncology, Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Center, Seattle, WA, USA., Department of Urology, Weill Cornell Medical College, Presbyterian Hospital New York, New York, NY, USA., Department of Surgery (Division of Urology), McGill University Health Centre, Montreal, QC, Canada., Department of Urology, David Medical Center, University of California at David, Sacramento, CA, USA., Princess Margaret Hospital, Toronto, ON, Canada., Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA., Division of Urology, University of Pennsylvania, Pennsylvania, PA, USA., Cross Cancer Institute, Edmonton, AB, Canada., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Department of Urology, University of Texas Southern Medical Center, Dallas, TX, USA., Department of Medicine, Case Comprehensive Cancer Center, Cleveland, USA., Division of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Department of Surgical Oncology (Urology), The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/36169695