INTRODUCTION
Muscle-invasive bladder cancer (BCa) is an indication for radical cystectomy (RC) and complete pelvic lymph node dissection, after an initial transurethral resection of the bladder tumor (TURBT). Neoadjuvant chemotherapy (NAC) before RC prolongs long-term survival and allows downstaging and assessment of response of the primary lesion.
Urothelial bladder cancer is mostly sensitive to cisplatin-based combination chemotherapy. Cisplatin gemcitabine combination has shown similar efficacy to the MVAC regimen but with lower toxicity in advanced BC and both regimens are now considered adequate options for NAC.
METHODS
All patients (pts) diagnosed with invasive BCa, stage cT2 or higher (cN0/+M0) after initial TURBT who were treated with NAC, either Cisplatin or Carboplatin plus Gemcitabine before RC, between 2012 and 2016 were eligible.
The primary objective was to evaluate pathological complete response (pCR) at RC after NAC, defined as pT0N0 or pTisN0, and its relationship with disease free survival (DFS).
All pathology specimens were reviewed for this analysis.
RESULTS
34 pts with BCa were treated with NAC followed by RC between 2012 and 2016. Median age was 67yo (range, 46-82), 85% (29) being males. Cisplatin plus Gemcitabine was the preferred regime (28 pts); 6 pts received Carboplatin plus Gemcitabine as NCT. 30 pts had 4 three-weekly cycles of NCT, 3 pts 3 cycles and 1 pt 2 cycles. 12 pts had to delay at least 1 cycle of NAC due to toxicity (35%) and 6 pts needed dose reductions (18%). 8 pts had grade III or IV toxicities (24%), mainly hematologic (63%). Upon pathologic review of the 34 TURBT specimens, 2 pts were T1 (6%), 28 T2 (82%), 2 T3 (6%) and 2 pts T4 (6%). Median DFS was 43.8 months for 11 pts with pCR and 36.8 months for the remaining pts (log rank test; p=0,732).
CONCLUSION
Although the DFS was numerically higher for the pts who obtained a pCR, the difference was not statistically significant in this 34 pts series. While less toxic, still only 20 pts were able to receive the full 12-week course of NAT with platin-gemcitabine combination without treatment delays or dose reductions.
