522 NEOADJUVANT ACCELERATED MVAC IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: A MULTI-INSTITUTIONAL PROSPECTIVELY ACCRUED COHORT (2013)

You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2013522 NEOADJUVANT ACCELERATED MVAC IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: A MULTI-INSTITUTIONAL PROSPECTIVELY ACCRUED COHORT Reza Mehrazin, E. Plimack, A. Kutikov, J. Tomaszewski, J. Hoffman-Censits, R. Viterbo, R. Greenberg, S. Ginzburg, A. Corcoran, C. Lallas, E. Trabulsi, Y-N. Wong, S. Boorjian, M. Smaldone, R. Uzzo, and D. Chen Reza MehrazinReza Mehrazin Philadelphia, PA More articles by this author , E. PlimackE. Plimack Philadelphia, PA More articles by this author , A. KutikovA. Kutikov Philadelphia, PA More articles by this author , J. TomaszewskiJ. Tomaszewski Philadelphia, PA More articles by this author , J. Hoffman-CensitsJ. Hoffman-Censits Philadelphia, PA More articles by this author , R. ViterboR. Viterbo Philadelphia, PA More articles by this author , R. GreenbergR. Greenberg Philadelphia, PA More articles by this author , S. GinzburgS. Ginzburg Philadelphia, PA More articles by this author , A. CorcoranA. Corcoran Philadelphia, PA More articles by this author , C. LallasC. Lallas Philadelphia, PA More articles by this author , E. TrabulsiE. Trabulsi Philadelphia, PA More articles by this author , Y-N. WongY-N. Wong Philadelphia, PA More articles by this author , S. BoorjianS. Boorjian Rochester, MN More articles by this author , M. SmaldoneM. Smaldone Philadelphia, PA More articles by this author , R. UzzoR. Uzzo Philadelphia, PA More articles by this author , and D. ChenD. Chen Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1916AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard Methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) has shown survival benefit as a neoadjuvant treatment for muscle invasive bladder cancer (MIBC). We sought to show the efficacy of neoadjuvant Accelerated MVAC (AMVAC) and assess post-surgical adverse events related to the chemotherapy. METHODS Pts with MIBC, T2-T4a, and N0-N1 Urothelial Carcinoma with a CrCl >=50 and adequate hepatic and marrow function were eligible. Patients with upper tract urothelial carcinoma were excluded. Patients received 3 cycles of AMVAC (methotrexate 3mg/m2, vinblastine 30 mg/m2, doxorubicin 30 mg/m2, cisplatin 70mg/m2) on day 1, with GCSF day 2 or 3, every 2 weeks. Pts with CrCl < 60 could received cisplatin split over 2 days at physician discretion. Radical cystectomy (open or robotic assisted laparocopic approach) was performed within 4-8 weeks of completion of chemotherapy. Primary endpoint was pathologic complete response (pCR) rate. Surgical outcomes were measured. RESULTS Accrual completed in 2/2012, with a total of 44 MIBC pts accrued at 2 institutions (FCCC, TJU) over a 26 month period. Median age was 64. Four withdrew from study early and are therefore not evaluable for response (2 physician discretion, 2 withdrawal of consent). Of the 44 pts for whom final data is available, 37 (84%) received all 3 cycles of AMVAC at full dose. In the intent to treat cohort, 43% (19 out of 44) of patients were down staged to pT1 or less [95% CI 2-58%]. 1 patient developed early metastasis therefore did not proceed to cystectomy. The remaining 43 patients all proceeded to cystectomy within 8 weeks of last chemo. Median time from start of chemotherapy to surgery was 68 days (range 24-91 days). 45.5% underwent robotic assisted laparoscopic technique, 78.1% received ileal conduit and 21.2% underwent continent urinary diversion. Median of 29.7 lymph nodes was obtained at the time of cystectomy (range: 9-62), median EBL was 448.4 ml, and median LOS was 9.7 days (range 5-30 days). 2 pts had grade 3 (abscess & fascial dehiscence) and 1 pt had a grade 4 (MI) perioperative complications as classified by Clavien-Dindo classification of surgical complications. Median follow-up for the study was 10.4 months. CONCLUSIONS Neoadjuvant AMVAC is well tolerated and preliminary results show similar efficacy compared to historical data with standard 12-week MVAC, suggesting that AMVAC for three cycles (6 weeks) is a safe and efficient alternative without increasing surgery related complications. All patients underwent cystectomy within 3 months of initiating chemotherapy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e214 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Reza Mehrazin Philadelphia, PA More articles by this author E. Plimack Philadelphia, PA More articles by this author A. Kutikov Philadelphia, PA More articles by this author J. Tomaszewski Philadelphia, PA More articles by this author J. Hoffman-Censits Philadelphia, PA More articles by this author R. Viterbo Philadelphia, PA More articles by this author R. Greenberg Philadelphia, PA More articles by this author S. Ginzburg Philadelphia, PA More articles by this author A. Corcoran Philadelphia, PA More articles by this author C. Lallas Philadelphia, PA More articles by this author E. Trabulsi Philadelphia, PA More articles by this author Y-N. Wong Philadelphia, PA More articles by this author S. Boorjian Rochester, MN More articles by this author M. Smaldone Philadelphia, PA More articles by this author R. Uzzo Philadelphia, PA More articles by this author D. Chen Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...