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Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical

Matteo Ferro1, Ottavio de Cobelli1,2, Gennaro Musi1

  • 1Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy.

Frontiers in Oncology
|May 28, 2021
PubMed
Summary

Three cycles of neoadjuvant cisplatin-gemcitabine chemotherapy may be as effective as four cycles for muscle-invasive bladder cancer, potentially offering reduced long-term toxicity. This finding supports considering fewer cycles in treatment protocols.

Keywords:
bladder cancercisplatin-based chemotherapyneoadjuvant chemotherapyobservational studyradical cystectomy

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Area of Science:

  • Oncology
  • Urology
  • Clinical Trials

Background:

  • Standard neoadjuvant treatment for muscle-invasive bladder cancer involves 3-4 cycles of cisplatin-based chemotherapy.
  • NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, but 3 cycles are frequently used.
  • This study compares outcomes between 3 and 4 cycles of neoadjuvant cisplatin-gemcitabine.

Purpose of the Study:

  • To evaluate if 3 vs. 4 cycles of neoadjuvant cisplatin-gemcitabine impact outcomes in muscle-invasive bladder cancer.
  • To compare pathologic downstaging, complete response, survival, and recurrence rates.
  • To assess the safety and efficacy of different neoadjuvant chemotherapy cycle counts.

Main Methods:

  • Retrospective analysis of 219 patients with muscle-invasive urothelial bladder cancer.
  • Patients received either 3 (cohort A) or 4 (cohort B) cycles of cisplatin-gemcitabine neoadjuvant therapy.
  • Comparison of outcomes including pathologic response, overall survival, cancer-specific survival, and recurrence time.

Main Results:

  • No significant difference in pathologic complete response, downstaging, recurrence, or cancer-specific survival between 3 and 4 cycles.
  • Univariate analysis showed worse non-cancer specific survival in the 4-cycle group (HR=2.53), but this was not confirmed multivariately.
  • The study included 160 patients in cohort A (3 cycles) and 59 in cohort B (4 cycles).

Conclusions:

  • Three cycles of neoadjuvant cisplatin-gemcitabine appear equally effective as four cycles for muscle-invasive bladder cancer.
  • Fewer cycles may be associated with reduced long-term toxicity.
  • Findings suggest 3 cycles could be a viable alternative in the neoadjuvant setting.