Feasibility of Cisplatin-Based Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer Patients With Diminished...

Area of Science:

• Oncology
• Nephrology
• Urology

Background:

• Cisplatin-based neoadjuvant chemotherapy (NAC) is standard for muscle-invasive bladder cancer before radical cystectomy.
• Limited data exist on chemotherapy tolerability and outcomes for patients with low glomerular filtration rate (GFR) receiving NAC.

Purpose of the Study:

• To evaluate NAC tolerability and outcomes in muscle-invasive bladder cancer patients with low GFR (< 60 mL/min).
• To compare outcomes between low GFR and normal GFR patients undergoing NAC.

Main Methods:

• Retrospective analysis of 124 patients receiving cisplatin-based NAC (2005-2016).
• Patients were stratified by pre-NAC GFR: low (< 60 mL/min) vs. normal (≥ 60 mL/min) using Cockcroft-Gault or MDRD formulas.
• Comparison focused on NAC tolerability, pathologic response, and cystectomy rates.

Main Results:

• Thirty low GFR patients (median 71 years) and 94 normal GFR patients (median 65 years) were analyzed.
• Low GFR patients had higher rates of NAC discontinuation (30% vs. 13%) and modifications (66% vs. 40%).
• Despite modifications, no differences in NAC cycles, cystectomy rates (93% each), or GFR change were observed. Pathologic complete response was higher in normal GFR patients (24% vs. 14%).

Conclusions:

• Low GFR patients experienced more NAC discontinuations and modifications but generally completed planned cycles.
• Cisplatin-based NAC is a viable treatment option for carefully selected muscle-invasive bladder cancer patients with GFR < 60 mL/min.