Neoadjuvant Chemotherapy for Patients with Muscle-invasive Urothelial Bladder Cancer Candidates for Curative Surgery: A Prospective Clinical Trial Based on Cisplatin Feasibility

Neoadjuvant chemotherapy demonstrated a survival benefit versus cystectomy alone in muscle-invasive urothelial bladder cancer. Despite this advantage, preoperative chemotherapy is not widely employed. When patients are unfit for cisplatin-based regimen, they are often candidates for immediate surgery. In our study, patients with muscle-invasive bladder cancer were treated with neoadjuvant chemotherapy. The principal objective was the rate of complete pathological response (pCR). Secondary end-points were disease-free survival (DFS), overall survival (OS) and toxicity.

Patients (n=72) with Eastern Cooperative Oncology Group (ECOG) performance status 0-1, clinical stage cT3-4, and/or N+ muscle-invasive bladder cancer were enrolled. The chemotherapy regimen was established according to the cisplatin feasibility. Thirty patients were treated with cisplatin/gemcitabine (Gem) and 42 with carboplatin/Gem.

The rate of pCR was 29.2%, 36% with cisplatin-based treatment and 23.8% with carboplatin (p=0.3574). DFS and OS were longer in pCR patients, while no difference was reported between cisplatin/Gem and Carboplatin/Gem groups.

Our results confirm the prognostic value of pCR in neoadjuvant chemotherapy for muscle-invasive bladder cancer. When the patients are not fit for cisplatin, a carboplatin/Gem regimen represents a valid option because of comparable long-term outcome. When cisplatin is not feasible, the exclusion of a preoperative treatment is not justified.

Anticancer research. 2017 Nov [Epub]

Giovanni Schinzari, Santa Monterisi, Francesco Pierconti, Giulia Nazzicone, Laura Marandino, Armando Orlandi, Marco Racioppi, Alessandra Cassano, Pierfrancesco Bassi, Carlo Barone, Ernesto Rossi

Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy ., Medical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy., Department of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy., Palliative Care Unit, Hospice Villa Speranza, Rome, Italy., Department of Urology, Università Cattolica del Sacro Cuore, Rome, Italy.