Identifying the Optimal Number of Neoadjuvant Chemotherapy Cycles in Patients with Muscle Invasive Bladder Cancer

Area of Science:

• Urology
• Oncology
• Chemotherapy

Background:

• Muscle invasive bladder cancer (MIBC) requires effective neoadjuvant chemotherapy (NAC).
• Cisplatin-based NAC is a standard treatment for MIBC prior to radical cystectomy.
• Optimizing the number of NAC cycles is crucial for improving patient outcomes.

Purpose of the Study:

• To compare the pathological response and survival rates between 3 and 4 cycles of cisplatin-based NAC.
• To evaluate the efficacy of different neoadjuvant chemotherapy durations in cT2-4N0M0 MIBC patients.

Main Methods:

• A cohort study analyzed 828 patients with cT2-4N0M0 MIBC treated with NAC and radical cystectomy (2000-2020).
• Patients received either 3 (n=384) or 4 (n=444) cycles of cisplatin-based NAC.
• Outcomes included pathological objective response (pOR), pathological complete response (pCR), cancer-specific survival, and overall survival.

Main Results:

• Four cycles of NAC demonstrated significantly higher pOR (49% vs. 42%) and pCR (28% vs. 21%) rates compared to three cycles.
• Multivariable analysis confirmed that 4 cycles of NAC were associated with increased pOR (OR 1.46) and pCR (OR 1.57).
• Four cycles of NAC were significantly associated with improved overall survival (HR 0.68) but not cancer-specific survival (HR 0.72).

Conclusions:

• Four cycles of cisplatin-based NAC lead to superior pathological response and improved overall survival in MIBC patients compared to three cycles.
• These findings can inform clinical decision-making and patient counseling regarding NAC duration.
• Prospective trials are warranted to validate these results and evaluate the cumulative toxicity associated with an increased number of NAC cycles.