Details

Autor(en) / Beteiligte

• D'Andrea, David
• Black, Peter C
• Zargar, Homayoun
• Dinney, Colin P
• Soria, Francesco
• Cookson, Michael S
• Montgomery, Jeffrey S
• Kassouf, Wassim
• Dall'Era, Marc A
• Sridhar, Srikala S
• McGrath, John S
• Wright, Jonathan L
• Thorpe, Andrew C
• Holzbeierlein, Jeff M
• Carrión, Diego M
• Di Trapani, Ettore
• Bivalacqua, Trinity J
• North, Scott
• Barocas, Daniel A
• Lotan, Yair
• Grivas, Petros
• Stephenson, Andrew J
• van Rhijn, Bas W
• Daneshmand, Siamak
• Spiess, Philippe E
• Shariat, Shahrokh F

Titel

Identifying the Optimal Number of Neoadjuvant Chemotherapy Cycles in Patients with Muscle Invasive Bladder Cancer

Ist Teil von

• The Journal of urology, 2022-01, Vol.207 (1), p.70-76

Ort / Verlag

United States

Erscheinungsjahr

2022

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• 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. 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. 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). 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.