Real-world data on neoadjuvant chemotherapy for localized muscle-invasive bladder cancer (2015-2024): A single-center
Maurice Tanguy1, Pillet Armelle2, Emambux Sheik2
1Département d'urologie et de transplantation rénale, centre hospitalier universitaire, 2, rue de la Milétrie, 86000 Poitiers, France.
Introduction:
The aim of this study was to evaluate the real-world effectiveness of neoadjuvant chemotherapy (NAC) regimens for muscle-invasive bladder cancer (MIBC) and to identify factors that may influence treatment response.
Methods:
We conducted a retrospective, single-center study from 2015 to 2024, analyzing real-world data on patients diagnosed with localized MIBC who received NAC prior to radical cystectomy. Patient demographics, pathological response rates and toxicities were recorded. Statistical analyses were performed to compare the outcomes between the two chemotherapy regimens and to identify factors affecting the pathologic response.
Results:
Eighty-nine patients were included, with 39 in the dose-dense MVAC (ddMVAC) group and 50 in the gemcitabine-cisplatin (GC) group. Twenty-five percent of the patients had a history of non-muscle-invasive bladder cancer (NMIBC). Patients treated with GC had a higher prevalence of cardiovascular disease (62 vs. 38% in the ddMVAC group) and lower glomerular filtration rates (84 vs. 92mL/min in the ddMVAC group). Dose reductions occurred in 38% of the GC group mainly due to thrombocytopenia and 13% in the MVAC group. There was no significant difference in postoperative complications between the two groups, although more severe complications (Clavien>2) occurred in the GC group. The complete response rate (ypT0N0) was similar in both groups with 56% for ddMVAC and 47% for GC. Multivariate analysis identified incomplete macroscopic transurethral resection of the bladder tumor and a history of NMIBC as factors negatively affecting the complete pathologic response rate.
Conclusion:
In this real-world study, incomplete TURBT and a history of NMIBC were independently associated with a lower pathological response to NAC, highlighting the importance of thorough initial tumor management. After 2022, favorable adherence to ddMVAC was observed without an apparent increase in severe toxicities in our cohort.
