Pathologic Response Rates of Gemcitabine/Cisplatin versus Methotrexate/Vinblastine/Adriamycin/Cisplatin Neoadjuvant Chemotherapy for Muscle Invasive Urothelial Bladder Cancer
Objectives. To compare pathologic outcomes after treatment with gemcitabine and cisplatin (GC) versus methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) in the neoadjuvant setting. Methods. Data was retrospectively collected on 178 patients with T2-T4 bladder cancer who underwent radical cystectomy between 2003 and 2011. Outcomes of interest included those with complete response (pT0) and any response (≤pT1). Odds ratios were calculated using multivariate logistic regression. Results. Compared to those who did not receive neoadjuvant chemotherapy, there were more patients with complete response (28% versus 9%, OR 3.11 (95% CI: 1.45–6.64), ) and any response (52% versus 25%, OR 3.23 (95% CI: 1.21–8.64), ). Seventy-two patients received GC ( ) or MVAC ( ). CR was achieved in 29% and 22% of GC and MVAC patients, respectively (multivariate OR 0.39, 95% CI 0.10–1.58). Any response (≤pT1) was achieved in 56% of GC and 45% of MVAC patients (multivariate OR 0.45, 95% CI 0.12–1.71). Conclusions. We observed similar pathologic response rates for GC and MVAC neoadjuvant chemotherapy in this cohort of patients with muscle invasive urothelial cancer (MIBC). Our findings support the use of GC as an alternative regimen in the neoadjuvant setting. 1. Introduction Bladder cancer, the fourth most common cancer in men, is commonly treated with radical cystectomy in patients with muscle invasive urothelial bladder cancer (MIBC). Survival is strongly correlated with both tumor and nodal stage with five-year survival of 15–35% in those with lymph node positive disease [1]. In patients treated with radical cystectomy, pathologic stage classification is higher than predicted clinical stage classification in 42% of patients [1]. Furthermore, occult lymph node disease is identified in 20–45% of patients at the time of cystectomy with clinical T2-T4 disease [1–3]. In addition, distant recurrences are seen in 20–50% of patients and outnumber local recurrences, which are seen in 5–15% of patients [2, 3]. Neoadjuvant chemotherapy is thought to provide additional benefit by treatment of “micrometastases” present in large numbers of patients with clinically localized disease. Several studies have evaluated the role of platinum-based neoadjuvant chemotherapy prior to radical cystectomy. Level 1 evidence supports use of neoadjuvant chemotherapy with a demonstrated 33% reduction in the risk of death among patients that received combination therapy compared with those that received surgery alone [4]. A meta-analysis further confirmed the benefit of platinum-based neoadjuvant
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