Multicenter evaluation of neoadjuvant and induction gemcitabine-carboplatin versus gemcitabine-cisplatin followed by radical cystectomy for muscle-invasive bladder cancer.

Autor: Einerhand SMH; Department of Surgical Oncology (Urology), The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands., Black AJ; Vancouver Prostate Centre, Vancouver, Canada., Zargar H; Department of Urology, Western Health, Melbourne, Australia., Fairey AS; USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA.; University of Alberta, Edmonton, AB, Canada., Dinney CP; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA., Mir MC; Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain., Krabbe LM; Department of Urology, University of Münster, Münster, Germany., Cookson MS; Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA., Jacobson NE; University of Alberta, Edmonton, AB, Canada., Montgomery JS; Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA., Vasdev N; Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK.; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Yu EY; Division of Oncology, Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Center, Seattle, WA, USA., Xylinas E; Department of Urology, Weill Cornell Medical College, Presbyterian Hospital New York, New York, NY, USA., Kassouf W; Department of Surgery (Division of Urology), McGill University Health Centre, Montreal, QC, Canada., Dall'Era MA; Department of Urology, David Medical Center, University of California at David, Sacramento, CA, USA., Sridhar SS; Princess Margaret Hospital, Toronto, ON, Canada., McGrath JS; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Aning J; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK.; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK., Shariat SF; Department of Urology, Weill Cornell Medical College, Presbyterian Hospital New York, New York, NY, USA.; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria., Wright JL; Division of Oncology, Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Center, Seattle, WA, USA., Thorpe AC; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK., Morgan TM; Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA., Holzbeierlein JM; Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA., Bivalacqua TJ; Division of Urology, University of Pennsylvania, Pennsylvania, PA, USA., North S; Cross Cancer Institute, Edmonton, AB, Canada., Barocas DA; Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Lotan Y; Department of Urology, University of Texas Southern Medical Center, Dallas, TX, USA., Grivas P; Division of Oncology, Department of Medicine, University of Washington School of Medicine and Fred Hutchinson Cancer Center, Seattle, WA, USA., Garcia JA; Department of Medicine, Case Comprehensive Cancer Center, Cleveland, USA., Stephenson AJ; Division of Urology, Rush University Medical Center, Chicago, IL, USA., Shah JB; Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Daneshmand S; USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA., Zargar-Shoshtari K; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., Spiess PE; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA., van Rhijn BWG; Department of Surgical Oncology (Urology), The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.; Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany., Black PC; Vancouver Prostate Centre, Vancouver, Canada., Mertens LS; Department of Surgical Oncology (Urology), The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. l.mertens@nki.nl.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2022 Nov; Vol. 40 (11), pp. 2707-2715. Date of Electronic Publication: 2022 Sep 28.
DOI: 10.1007/s00345-022-04160-7
Abstrakt: Purpose: Cisplatin-based chemotherapy followed by radical cystectomy (RC) is recommended in patients with muscle-invasive bladder cancer (MIBC). However, up to 50% of patients are cisplatin ineligible. The aim of this study was to compare clinical outcomes after ≥ 3 cycles of preoperative gemcitabine-carboplatin (gem-carbo) versus gemcitabine-cisplatin (gem-cis).
Methods: We identified 1865 patients treated at 19 centers between 2000 and 2013. Patients were included if they had received ≥ 3 cycles of neoadjuvant (cT2-4aN0M0) or induction (cTanyN + M0) gem-carbo or gem-cis followed by RC.
Results: We included 747 patients treated with gem-carbo (n = 147) or gem-cis (n = 600). Patients treated with gem-carbo had a higher Charlson Comorbidity Index (p = 0.016) and more clinically node-positive disease (32% versus 20%; p = 0.013). The complete pathological response (pCR; ypT0N0) rate did not significantly differ between gem-carbo and gem-cis (20.7% versus 22.1%; p = 0.73). Chemotherapeutic regimen was not significantly associated with pCR (OR 0.99 [95%CI 0.61-1.59]; p = 0.96), overall survival (OS) (HR 1.20 [95%CI 0.85-1.67]; p = 0.31), or cancer-specific survival (CSS) (HR 1.35 [95%CI 0.93-1.96]; p = 0.11). Median OS of patients treated with gem-carbo and gem-cis was 28.6 months (95%CI 18.1-39.1) and 45.1 months (95%CI 32.7-57.6) (p = 0.18), respectively. Median CSS of patients treated with gem-carbo and gem-cis was 28.8 months (95%CI 9.8-47.8) and 71.0 months (95%CI median not reached) (p = 0.02), respectively. Subanalyses of the neoadjuvant and induction setting did not show significant survival differences.
Conclusion: Our results show that a subset of cisplatin-ineligible patients with MIBC achieve pCR on gem-carbo and that survival outcomes seem comparable to gem-cis provided patients are able to receive ≥ 3 cycles and undergo RC.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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