The Efficacy of Neoadjuvant Cabazitaxel and Cisplatin in Patients with Bladder Cancer - Expert Commentary

Cisplatin-based chemotherapy is the standard-of-care neoadjuvant treatment for patients with muscle-invasive bladder cancer (MIBC). Taxanes were evaluated previously combined with cisplatin in the neoadjuvant setting. However, it is unclear if cabazitaxel, a novel taxane, synergizes with cisplatin.

A recently published single-arm phase II trial by Challapalli et al. in Clinical Genitourinary Cancer investigated the effectiveness and safety of cabazitaxel and cisplatin as a neoadjuvant regimen in patients with MIBC eligible for radical cystectomy. The study recruited 26 evaluable patients who received a median of 4 cycles of the cabazitaxel-cisplatin combination.

The objective response rate (ORR) was 57.7%, including pathologic complete response and pathologic downstaging. The study was designed to assume that an ORR of< 35% would not warrant further investigation of cabazitaxel and cisplatin in an expanded phase II/III setting. The pathologic complete response rates and tumor downstaging (ypTa, Tis, T1N0) were 34.6% and 23.1%, respectively. The 5-year overall survival in the whole population or those who achieved ORR were 70% and 100%, respectively. Patients with no pathologic downstaging had lower survival (5-year OS: 36%). Toxicity profiles were within the expected range. Cabazitaxel did not have an adverse impact on surgical outcomes in terms of hospital stay or postoperative complications.

The combination of cabazitaxel and cisplatin showed promise in the neoadjuvant setting. Additional direct comparisons with other cisplatin-based regimens are warranted. As immunotherapy starts making inroads into the neoadjuvant setting, different chemotherapy combination backbones may synergize better with immunotherapy.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

References:

  1. Challapalli A, Masson S, White P, Dailami N, Pearson S, Rowe E, et al. A Single-arm Phase II Trial of Neoadjuvant Cabazitaxel and Cisplatin Chemotherapy for Muscle-Invasive Transitional Cell Carcinoma of the Urinary Bladder. Clin Genitourin Cancer. 2021;19(4):325–32.

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