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Identifying the Optimal Number of Neoadjuvant Chemotherapy Cycles in Patients with Muscle-Invasive Bladder Cancer. The Journal of urology D'Andrea, D., Black, P. C., Zargar, H., Dinney, C. P., Soria, F., Cookson, M. S., Montgomery, J. S., Kassouf, W., Dall'Era, M. A., Sridhar, S. S., McGrath, J. S., Wright, J. L., Thorpe, A. C., Holzbeierlein, J. M., Carrion, D. M., Di Trapani, E., Bivalacqua, T. J., North, S., Barocas, D. A., Lotan, Y., Grivas, P., Stephenson, A. J., van Rhijn, B. W., Daneshmand, S., Spiess, P. E., Shariat, S. F., Zargar-Shoshtar, K., Mertens, L. S., Fairey, A. S., Mir, M. C., Krabbe, L., Jacobsen, N., Vasdev, N., Yu, E. Y., Xylinas, E., Pradere, B., Pichler, R., Campain, N. J., Seah, J., Ercole, C. E., Horenblas, S., Aning, J., Morgan, T. M., Shah, J. B., Moschini, M. 2021: 101097JU0000000000002190

Abstract

PURPOSE: To investigate the pathologic response rates and survival associated with 3 versus 4 cycles of cisplatin-based NAC in patients with cT2-4N0M0 MIBC.MATERIAL AND METHODS: In this cohort study we analyzed clinical data of 828 patients treated with NAC and RC between 2000 and 2020. A total of 384 and 444 patients were treated with 3 and 4 cycles of NAC, respectively. Pathologic objective response (pOR; ypT0-Ta-Tis-T1 N0), pathologic complete response (pCR; ypT0 N0), cancer-specific survival (CSS) and overall survival (OS) 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 OS (HR 0.68; 95%CI 0.49, 0.94; p=0.02) but not with CSS (HR 0.72; 95%CI 0.50, 1.04; p=0.08).CONCLUSIONS: 4 cycles of NAC achieved better pathologic response and survival compared to 3 cycles. These findings may aid clinicians in counselling 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.

View details for DOI 10.1097/JU.0000000000002190

View details for PubMedID 34445891