Identifying the Optimal Number of Neoadjuvant Chemotherapy Cycles in Patients with Muscle Invasive Bladder Cancer
Language English Country United States Media print-electronic
Document type Journal Article, Multicenter Study
- Keywords
- drug administration schedule, neoadjuvant therapy, survival, urinary bladder neoplasms,
- MeSH
- Cystectomy MeSH
- Neoplasm Invasiveness MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Urinary Bladder Neoplasms drug therapy mortality pathology surgery MeSH
- Neoadjuvant Therapy statistics & numerical data MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
PURPOSE: We investigated the pathological response rates and survival associated with 3 vs 4 cycles of cisplatin-based neoadjuvant chemotherapy (NAC) in patients with cT2-4N0M0 muscle invasive bladder cancer. MATERIALS AND METHODS: In this cohort study we analyzed clinical data of 828 patients treated with NAC and radical cystectomy between 2000 and 2020. A total of 384 and 444 patients were treated with 3 and 4 cycles of NAC, respectively. Pathological objective response (pOR; ypT0-Ta-Tis-T1 N0), pathological complete response (pCR; ypT0 N0), cancer-specific survival and overall survival were investigated. RESULTS: pOR and pCR were achieved in 378 (45%; 95% CI 42, 49) and 207 (25%; 95% CI 22, 28) patients, respectively. Patients treated with 4 cycles of NAC had higher pOR (49% vs 42%, p=0.03) and pCR (28% vs 21%, p=0.02) rates compared to those treated with 3 cycles. This effect was confirmed on multivariable logistic regression analysis (pOR OR 1.46 p=0.008, pCR OR 1.57, p=0.007). On multivariable Cox regression analysis, 4 cycles of NAC were significantly associated with overall survival (HR 0.68; 95% CI 0.49, 0.94; p=0.02) but not with cancer-specific survival (HR 0.72; 95% CI 0.50, 1.04; p=0.08). CONCLUSIONS: Four cycles of NAC achieved better pathological response and survival compared to 3 cycles. These findings may aid clinicians in counseling patients and serve as a benchmark for prospective trials. Prospective validation of these findings and assessment of cumulative toxicity derived from an increased number of cycles are needed.
Cross Cancer Institute Edmonton Alberta Canada
Department of Oncology University of Alberta Edmonton Alberta Canada
Department of Surgery McGill University Health Center Montreal Canada
Department of Urologic Sciences University of British Columbia Vancouver British Columbia Canada
Department of Urologic Surgery Vanderbilt University Medical Center Nashville Tennessee
Department of Urology 2nd Faculty of Medicine Charles University Prag Czech Republic
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology European Institute of Oncology IRCCS Milan Italy
Department of Urology Freeman Hospital Newcastle Upon Tyne UK
Department of Urology Louisiana Paz University Hospital Madrid Spain
Department of Urology MD Anderson Cancer Center Houston Texas
Department of Urology Molinette Hospital University of Turin Turin Italy
Department of Urology University of California at Davis Davis Medical Center Sacramento California
Department of Urology University of Kansas Medical Center Kansas City Kansas
Department of Urology University of Michigan Health System Ann Arbor Michigan
Department of Urology University of Oklahoma College of Medicine Oklahoma City Oklahoma
Department of Urology University of Texas Southwestern Medical Center Dallas Texas
Department of Urology University of Washington Seattle Washington
Department of Urology Western Health Melbourne Australia
Departments of Urology Weill Cornell Medical College New York New York
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