We found only 344 (12.6%) radical cystectomy patients received neoadjuvant chemotherapy. The agents most commonly used were gemcitabine (72.3%), cisplatin (55.2%), and carboplatin (31.1%). The regimens most commonly used were gemcitabine-cisplatin (45.3%), gemcitabine-carboplatin (24.1%), and methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC; 6.7%). Use of neoadjuvant chemotherapy more than tripled during the study period, from 5.7% in 2001 to 17.3% in 2011 (p<0.001). 6.7%). Importantly, there was no significant difference in NAC use or type according to chronic renal disease status.
The quality of the regimen administered impacted survival outcomes, as M-VAC use was significantly associated with better overall survival among patients diagnosed with stage II bladder cancer (hazard ratio 0.24, 95% confidence interval 0.07-0.86; p=0.030]. However, as noted above, M-MVAC was the least commonly used regimen observed in only 6.7% of patients.
In conclusion, we observed significant underuse of neoadjuvant chemotherapy. We also noted significant quality concerns as <50% of patients who received chemotherapy were cisplatin-based and <1% of all patients who underwent radical cystectomy received M-VAC. The findings are not important regarding data interpretation specially in large population-based studies, but highlight the need for targeted interventions to improve the use and quality of chemotherapy use in bladder cancer patients.
Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX
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