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Multicenter evaluation of neoadjuvant and induction gemcitabine-carboplatin versus gemcitabine-cisplatin followed by radical cystectomy for muscle-invasive bladder cancer. World journal of urology Einerhand, S. M., Black, A. J., Zargar, H., Fairey, A. S., Dinney, C. P., Mir, M. C., Krabbe, L. M., Cookson, M. S., Jacobson, N. E., Montgomery, J. S., Vasdev, N., Yu, E. Y., Xylinas, E., Kassouf, W., Dall'Era, M. A., Sridhar, S. S., McGrath, J. S., Aning, J., Shariat, S. F., Wright, J. L., Thorpe, A. C., Morgan, T. M., Holzbeierlein, J. M., Bivalacqua, T. J., North, S., Barocas, D. A., Lotan, Y., Grivas, P., Garcia, J. A., Stephenson, A. J., Shah, J. B., Daneshmand, S., Zargar-Shoshtari, K., Spiess, P. E., van Rhijn, B. W., Black, P. C., Mertens, L. S. 2022

Abstract

Cisplatin-based chemotherapy followed by radical cystectomy (RC) is recommended in patients with muscle-invasive bladder cancer (MIBC). However, up to 50% of patients are cisplatin ineligible. The aim of this study was to compare clinical outcomes after?=?3 cycles of preoperative gemcitabine-carboplatin (gem-carbo) versus gemcitabine-cisplatin (gem-cis).We identified 1865 patients treated at 19 centers between 2000 and 2013. Patients were included if they had received?=?3 cycles of neoadjuvant (cT2-4aN0M0) or induction (cTanyN?+?M0) gem-carbo or gem-cis followed by RC.We included 747 patients treated with gem-carbo (n?=?147) or gem-cis (n?=?600). Patients treated with gem-carbo had a higher Charlson Comorbidity Index (p?=?0.016) and more clinically node-positive disease (32% versus 20%; p?=?0.013). The complete pathological response (pCR; ypT0N0) rate did not significantly differ between gem-carbo and gem-cis (20.7% versus 22.1%; p?=?0.73). Chemotherapeutic regimen was not significantly associated with pCR (OR 0.99 [95%CI 0.61-1.59]; p?=?0.96), overall survival (OS) (HR 1.20 [95%CI 0.85-1.67]; p?=?0.31), or cancer-specific survival (CSS) (HR 1.35 [95%CI 0.93-1.96]; p?=?0.11). Median OS of patients treated with gem-carbo and gem-cis was 28.6 months (95%CI 18.1-39.1) and 45.1 months (95%CI 32.7-57.6) (p?=?0.18), respectively. Median CSS of patients treated with gem-carbo and gem-cis was 28.8 months (95%CI 9.8-47.8) and 71.0 months (95%CI median not reached) (p?=?0.02), respectively. Subanalyses of the neoadjuvant and induction setting did not show significant survival differences.Our results show that a subset of cisplatin-ineligible patients with MIBC achieve pCR on gem-carbo and that survival outcomes seem comparable to gem-cis provided patients are able to receive?=?3 cycles and undergo RC.

View details for DOI 10.1007/s00345-022-04160-7

View details for PubMedID 36169695