Neoadjuvant chemotherapy with gemcitabine/cisplatin vs. methotrexate/vinblastine/doxorubicin/cisplatin for muscle-invasive urothelial carcinoma of the bladder: A retrospective analysis from the University of Southern California

• Published in: Urologic oncology 2013-11, Vol.31 (8), p.1737-1743
• Main Authors: Fairey, Adrian S., M.D., M.S, Daneshmand, Siamak, M.D, Quinn, David, M.D, Dorff, Tanya, M.D, Dorin, Ryan, M.D, Lieskovsky, Gary, M.D, Schuckman, Anne, M.D, Cai, Jie, M.S, Miranda, Gus, Skinner, Eila C., M.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Animals; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - surgery; Cisplatin - administration & dosage; Cystectomy - methods; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Doxorubicin - administration & dosage; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Methotrexate - administration & dosage; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Outcome Assessment (Health Care) - statistics & numerical data; Proportional Hazards Models; Retrospective Studies; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - surgery; Urology; Vinblastine - administration & dosage
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2012.07.005

Abstract Objectives We evaluated pathologic and survival outcomes of GC (gemcitabine/cisplatin) and methotrexate/vinblastine/doxorubicin/cisplatin (M-VAC) neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC). Materials and methods A retrospective analysis of prospectively collected data on 116 patients who received NAC (GC: n = 58; M-VAC: n = 58) before radical cystectomy and superextended pelvic lymph node dissection for clinical stage T2-4N0M0 bladder cancer was performed. The outcomes were complete response rate (CRR; pT0N0), partial response rate (PRR; pT0N0, pTaN0, pT1N0, or pTisN0), overall mortality (OM), and recurrence. The Kaplan-Meier method and multivariable Cox regression analysis were used to analyze OM. The cumulative incidence method and Fine and Gray's competing risk regression analysis were used to analyze recurrence. Results The median follow-up duration was 2.1 years for the GC group and 7.4 years for the M-VAC group ( P < 0.001). There were no statistically significant differences between the GC and M-VAC groups with regard to CRR (27.3% vs. 17.1%, P = 0.419) or PRR (45.5% vs. 37.1%, P = 0.498). The predicted 5-year freedom from OM rate ( P = 0.634) and cumulative incidence of recurrence rate ( P = 0.891) did not differ between the GC and M-VAC groups. Multivariable analysis showed that there was no independent association between type of NAC and OM ( P = 0.721) or recurrence ( P = 0.065). Conclusions Pathologic and survival outcomes did not differ in patients who received GC and M-VAC NAC. These data support the use of the GC regimen in the neoadjuvant setting.