Efficacy of Split Schedule Versus Conventional Schedule Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive...

Area of Science:

• Oncology
• Urologic Oncology
• Chemotherapy

Background:

• Neoadjuvant cisplatin-based chemotherapy (NAC) is the standard of care for muscle-invasive bladder carcinoma (MIBC).
• Renal impairment prevents many patients from receiving standard cisplatin doses.
• A split schedule (SS) of cisplatin is an alternative for patients with renal impairment.

Purpose of the Study:

• To compare complete (pT0) and partial (
• To evaluate the efficacy of split-schedule cisplatin as an alternative for patients unable to receive full-dose cisplatin due to renal impairment.

Main Methods:

• Retrospective analysis of 80 matched patients with MIBC receiving either SS or CS cisplatin.
• 1:1 matching based on chemotherapy regimen, number of cycles, tumor histology, and clinical stage.
• Comparison of complete pathologic response (pT0) and partial pathologic response (

Main Results:

• Complete pathologic response (pT0) rates were 17.5% in the SS group and 32.5% in the CS group (p=0.21).
• The odds ratio for pT0 with SS cisplatin was 0.45 (95% CI, 0.16-1.31).
• Split-schedule cisplatin was associated with numerically lower, but not statistically significant, pathologic response rates compared to the conventional schedule.

Conclusions:

• Split-schedule cisplatin demonstrated numerically lower pathologic response rates compared to the conventional schedule in MIBC.
• While not statistically significant, these findings suggest a potential decrease in efficacy with the split schedule.
• Further prospective studies are warranted to confirm the efficacy and safety of split-schedule cisplatin in MIBC patients with renal impairment.