Four versus Three Cycles of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Implications for Pathologic Response and Survival. Journal Article

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Authors: Patel, HD; Patel, SH; Blanco-Martinez, E; Kuzbel, J; Chen, VS; Druck, A; Koehne, EL; Patel, PM; Doshi, CP; Hahn, NM; Hoffman-Censits, JH; Berg, S; Bivalacqua, TJ; Kates, M; Quek, ML
Article Title: Four versus Three Cycles of Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Implications for Pathologic Response and Survival.
Abstract: PURPOSE: Ideal number of neoadjuvant chemotherapy (NAC) cycles for muscle-invasive bladder cancer is uncertain with 3 to 4 representing the standard of care (SOC). We compared ypT0 rates and survival between patients receiving 4 versus 3 cycles of NAC with evaluation of chemotherapy-related toxicity for correlation with tumor chemosensitivity and pathologic response. MATERIALS AND METHODS: Patients receiving NAC followed by radical cystectomy for cT2-4N0M0 urothelial carcinoma from two institutions were included. Primary study groups included 4 cisplatin-based NAC cycles, 3 cisplatin-based NAC cycles, and non-SOC NAC (1-2 cycles or non-cisplatin-based) to compare ypT0/=ypT1 rates and survival. A cohort of patients not receiving NAC was included for pathologic reference. RESULTS: Of 693 total patients, 318 (45.9%) received NAC. ypT0 and =ypT1 rates were 42/157 (26.8%) and 86/157 (54.8%) for 4 cycles, 38/114 (33.3%) and 71/114 (62.3%) for 3 cycles, and 6/47 (12.8%) and 13/47 (27.7%) for non-SOC (p=0.03 and p 0.01, respectively). Pathologic response appeared higher among patients receiving 3 cycles due to toxicity (ypT0: 29/77 (37.7%); =ypT1: 51/77 (66.2%)) but did not reach statistical significance. Toxicities leading to treatment modifications were thrombocytopenia (32.1%), neutropenia (27.2%), renal insufficiency (22.2%), and constitutional symptoms (18.5%). Non-SOC patients had lower Kaplan-Meier survival (cT2-cT4N0M0: log-rank p=0.07; cT2N0M0: log-rank p=0.02). There were no statistically significant differences in survival between 4 and 3 cycles (HR 1.00 (95%CI 0.57-1.74), p=0.99). CONCLUSIONS: Patients completing 3 cycles of cisplatin-based NAC have similar pathologic response and short-term survival compared to 4 cycles. Further evaluation of patients experiencing toxicity as a potential marker of tumor chemosensitivity is needed.
Journal Title: The Journal of urology
ISSN: 1527-3792; 0022-5347
Publisher: Unknown  
Date Published: 2021