MP55-19 EFFICACY OF NEOADJUVANT CHEMOTHERAPY IN BLADDER CANCER (2014)

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2014MP55-19 EFFICACY OF NEOADJUVANT CHEMOTHERAPY IN BLADDER CANCER Hristos Z. Kaimakliotis, Jose A. Pedrosa, M Francesca Monn, K Clint Cary, Joshua Roth, Timothy A. Masterson, Thomas A. Gardner, Richard S. Foster, Liang Cheng, Richard Bihrle, and Michael O. Koch Hristos Z. KaimakliotisHristos Z. Kaimakliotis More articles by this author , Jose A. PedrosaJose A. Pedrosa More articles by this author , M Francesca MonnM Francesca Monn More articles by this author , K Clint CaryK Clint Cary More articles by this author , Joshua RothJoshua Roth More articles by this author , Timothy A. MastersonTimothy A. Masterson More articles by this author , Thomas A. GardnerThomas A. Gardner More articles by this author , Richard S. FosterRichard S. Foster More articles by this author , Liang ChengLiang Cheng More articles by this author , Richard BihrleRichard Bihrle More articles by this author , and Michael O. KochMichael O. Koch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1567AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Use of neoadjuvant chemotherapy (NACT) has demonstrated a survival advantage in urothelial bladder cancer (UC). We sought to compare the efficacy of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) vs. gemcitabine and cisplatin (GC) in primary UC and in the subset of patients with variant histology (VH). Methods Using the Indiana University Bladder Cancer Database, we conducted a retrospective analysis of patients with UC undergoing radical cystectomy for cT2-T4aN0Mx. Patients undergoing NACT were compared to cystectomy alone to assess efficacy of regimen used. Patients with cT2-T4aN+Mx were excluded, and patients with any VH were compared in a secondary analysis. Fisher’s exact test and multivariable logistic regression were used to assess response to NACT, and log rank test for differences in survival. Results After exclusion criteria, 354 patients made up the final study cohort. NACT regimens and pathologic outcomes are shown in the Table below. Both regimens were effective in down-staging when compared to cystectomy alone. When comparing MVAC to GC there was no difference. After adjusting for other covariates, MVAC and GC were significant predictors of pathologic complete response (pCR = pT0N0) compared to cystectomy alone, OR 3.41 (95% CI 1.20-9.64, p=0.021) and OR 3.04 (95% CI 1.20-6.77, p=0.007), respectively. Pathologic down-staging (pDS = <pT2N0Mx) was also improved in the MVAC and GC groups compared to cystectomy alone, OR 6.63 (95% CI 2.61-16.88, p<0.001) and OR 3.43 (95% CI 1.78-6.60, p<0.001), respectively. MVAC (p=0.022) and GC (p=0.046) demonstrated significant overall survival advantages compared to cystectomy alone (see Figure). NACT did not confer a survival benefit in VH patients, but was limited by small numbers. Conclusions Neoadjuvant MVAC and GC are significant predictors of pCR and pDS compared to cystectomy alone, conferring a higher 5-year and median overall survival. There was no difference between regimens, although pDS, an important prognostic indicator for survival, approached significance. NACT did not confer a benefit in patients with VH. Response MVAC (n=26) None (n=270) p-value pT0 10 (38.5%) 22 (8.1%) < 0.001 pT0N0 8 (30.8%) 21 (7.8%) < 0.001 < pT2N0Mx 16 (61.5%) 40 (14.8%) < 0.001 Gem/Cis (n=58) None (n=270) pT0 14 (24.1%) 22 (8.1%) < 0.001 pT0N0 13 (22.4%) 21 (7.8%) 0.001 < pT2N0Mx 24 (41.4%) 40 (14.8%) < 0.001 MVAC (n=26) Gem/Cis (n=58) pT0 10 (38.5%) 14 (24.1%) 0.179 pT0N0 8 (30.8%) 13 (22.4%) 0.414 < pT2N0Mx 16 (61.5%) 24 (41.4%) 0.070 Variant histology Any NACT (n=14) None (n=83) pT0 1 (7.1%) 3 (3.6%) 0.539 pT0N0 1 (7.1%) 3 (3.6%) 0.539 < pT2N0Mx 1 (7.1%) 3 (3.6%) 0.539 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e562-e563 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Hristos Z. Kaimakliotis More articles by this author Jose A. Pedrosa More articles by this author M Francesca Monn More articles by this author K Clint Cary More articles by this author Joshua Roth More articles by this author Timothy A. Masterson More articles by this author Thomas A. Gardner More articles by this author Richard S. Foster More articles by this author Liang Cheng More articles by this author Richard Bihrle More articles by this author Michael O. Koch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...