Gemcitabine and cisplatin neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma: Predicting response and assessing outcomes

Abstract Purpose To evaluate gemcitabine-cisplatin (GC) neoadjuvant cisplatin-based chemotherapy (NAC) for pathologic response (pR) and cancer-specific outcomes following radical cystectomy (RC) for muscle-invasive bladder cancer and identify clinical parameters associated with pR. Materials and met...

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Bibliographic Details
Published in:Urologic oncology 2015-05, Vol.33 (5), p.204.e1-204.e7
Main Authors: Gandhi, Nilay M., M.D, Baras, Alexander, M.D., Ph.D, Munari, Enrico, M.D, Faraj, Sheila, M.D, Reis, Leonardo O., M.D., Ph.D, Liu, Jen-Jane, M.D, Kates, Max, M.D, Hoque, Mohammad Obaidul, D.S.S., Ph.D, Berman, David, M.D., Ph.D, Hahn, Noah M., M.D, Eisenberger, Mario, M.D, Netto, George J., M.D, Schoenberg, Mark P., M.D, Bivalacqua, Trinity J., M.D., Ph.D
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Bladder cancer
Cisplatin - administration & dosage
Cisplatin - therapeutic use
Cohort Studies
Deoxycytidine - administration & dosage
Deoxycytidine - analogs & derivatives
Deoxycytidine - therapeutic use
Female
Gemcitabine-cisplatin
Humans
Male
Middle Aged
Neoadjuvant chemotherapy
Neoadjuvant Therapy - methods
Outcome Assessment (Health Care) - methods
Pathologic response
Survival Rate
Urologic Neoplasms - drug therapy
Urologic Neoplasms - pathology
Urology
Urothelial carcinoma
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Summary:Abstract Purpose To evaluate gemcitabine-cisplatin (GC) neoadjuvant cisplatin-based chemotherapy (NAC) for pathologic response (pR) and cancer-specific outcomes following radical cystectomy (RC) for muscle-invasive bladder cancer and identify clinical parameters associated with pR. Materials and methods We studied 150 consecutive cases of muscle-invasive bladder cancer that received GC NAC followed by open RC (2000–2013). A cohort of 121 patients treated by RC alone was used for comparison. Pathologic response and cancer-specific survival (CSS) were compared. We created the Johns Hopkins Hospital Dose Index to characterize chemotherapeutic dosing regimens and accurately assess sufficient neoadjuvant dosing regarding patient tolerance. Results No significant difference was noted in 5-year CSS between GC NAC (58%) and non-NAC cohorts (61%). The median follow-up was 19.6 months (GC NAC) and 106.5 months (non-NAC). Patients with residual non–muscle-invasive disease after GC NAC exhibit similar 5-year CSS relative to patients with no residual carcinoma ( P = 0.99). NAC pR (≤pT1) demonstrated improved 5-year CSS rates (90.6% vs. 27.1%, P
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2015.02.011