AUA 2017: Safety and Efficacy Gemcitabine-Cisplatin Split Dose as a Neoadjuvant Chemotherapy for Muscle Invasive Bladder Cancer

Boston, MA ( Dr. Abhelhafez presented his group’s results of the safety and efficacy of gemcitabine-cisplatin split dose for neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (MIBC) at this afternoon’s invasive bladder cancer podium session. We have level 1 evidence to support neoadjuvant chemotherapy for MIBC patients, although many patients are unable to tolerate the cisplatin-based regimens. The objective of the current study was to study the effectiveness and safety of split dose gemcitabine and cisplatin for NAC among patients with MIBC.

To perform this study, the authors included 82 patients between 2004 and 2015 that received a gemcitabine/cisplatin split dose followed by radical cystectomy for patients with T2-T4 bladder cancer. All patients received 1,000 mg/m2 of gemcitabine and 35 mg/m2 of cisplatin given on days 1 and 8 of a 21-day cycle for 4 cycles. The authors recorded preoperative clinical parameters, number of cycles completed, complications of NAC, and pathologic response. Among these 82 patients, only 10 patients (12%) could not complete 4 cycles secondary to complications. There were 38 patients (46%) down staged to ≤pT1 and 32 patients (39%) achieved complete response (pT0). Median follow up time was 29 months, and on univariate analysis for detecting predictors affecting pathologic response, there was no difference with respect to gender (p=0.74), race (p=0.78), age (p=0.38), BMI (p=0.82), T-stage (p=0.98), N-stage (p=0.62), presence of carcinoma in situ (p=0.10), squamous differentiation (p=0.23) and presence of lymphovascular invasion (p=0.75). Limitations of this trial are several, including lack of a comparison group, small sample size and patients with unavailable follow-up being excluded from the study.

In conclusion, splitting the dose of gemcitabine and cisplatin for patients receiving NAC for MIBC has an adequate pathologic response in this small retrospective study. External validation in a multi-center setting is required before widespread adoption.

Speaker: Mohamed Abdelhafez, Assiut University Hospital, Assiut, Egypt

Co-Authors: Michael Williams

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA