INTRODUCTION :Randomized trials in patients with muscle invasive bladder cancer have established that neoadjuvant cisplatin- based chemotherapy before radical cistectomy improves long term survival compared to surgery alone, providing evidence that multimodality treatment should be the standard of care. Nevertheless, neoadjuvant cisplatin chemotherapy has been underused due to concerns that clinical benefit is limited to a subset of patients while all patients are exposed to chemotherapy toxicity.
Nowadays consensus regarding the optimal cisplatin regimen, dose and duration of treatment is still lacking.
The aim of this paper is to assess our experience and review a single institute data in the neoadjuvant bladder cancer setting, focusing on the pathologic response rate (<T2) – downstaging to non muscle-invasive disease – recurrence free survival (RFS) and toxicity asociated with chemotherapy.
METHODS AND RESULTS:We evaluated sixteen patients who received neoadjuvant cisplatin based chemotherapy between 2015 to 2018 in our institution . Eleven out of the sixteen (68%) eligible patients downstaged to < pT2 whilst 43% responded completely to neoadjuvant chemotherapy. The 18 month RFS rate responders (<T2) and nonresponders was 80% and 40% respectively (log-rank p=0,039).Five patients (31%) required toxicity related dose modifications. The most frequent treatment–related toxicity was neutropenia ( 38%, grade 2/3 ). No patient failed to undergo cistectomy as a result of chemotherapy associated toxicities.
CONCLUSIONS: Currently we know that patients that respond to cisplatin neoadjuvant chemotherapy in the muscle invasive bladder cancer setting have significantly better RFS compared with nonresponders. The results obtained in our small series regarding pathologic response rates are similar to those published in recent literature. On the other hand,chemotherapy toxicity may delay time to cistectomy; nevertheless complications related to toxicity can be well handed and treated.
