Frontiers in Oncology (May 2021)

Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Multi-Institutional Analysis

  • Matteo Ferro,
  • Ottavio de Cobelli,
  • Ottavio de Cobelli,
  • Gennaro Musi,
  • Giuseppe Lucarelli,
  • Daniela Terracciano,
  • Daniela Pacella,
  • Tommaso Muto,
  • Angelo Porreca,
  • Gian Maria Busetto,
  • Francesco Del Giudice,
  • Francesco Soria,
  • Paolo Gontero,
  • Francesco Cantiello,
  • Rocco Damiano,
  • Fabio Crocerossa,
  • Abdal Rahman Abu Farhan,
  • Riccardo Autorino,
  • Mihai Dorin Vartolomei,
  • Mihai Dorin Vartolomei,
  • Matteo Muto,
  • Michele Marchioni,
  • Andrea Mari,
  • Luca Scafuri,
  • Andrea Minervini,
  • Nicola Longo,
  • Francesco Chiancone,
  • Sisto Perdona,
  • Pietro De Placido,
  • Antonio Verde,
  • Michele Catellani,
  • Stefano Luzzago,
  • Francesco Alessandro Mistretta,
  • Pasquale Ditonno,
  • Vincenzo Francesco Caputo,
  • Michele Battaglia,
  • Stefania Zamboni,
  • Alessandro Antonelli,
  • Alessandro Antonelli,
  • Francesco Greco,
  • Giorgio Ivan Russo,
  • Rodolfo Hurle,
  • Nicolae Crisan,
  • Matteo Manfredi,
  • Francesco Porpiglia,
  • Giuseppe Di Lorenzo,
  • Giuseppe Di Lorenzo,
  • Felice Crocetto,
  • Carlo Buonerba,
  • Carlo Buonerba

DOI
https://doi.org/10.3389/fonc.2021.651745
Journal volume & issue
Vol. 11

Abstract

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BackgroundThree or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes.MethodsPatients with histologically confirmed muscle-invasive UBC included in this retrospective study had to be treated with either 3 (cohort A) or 4 (cohort B) cycles of cisplatin-gemcitabine as neoadjuvant therapy before undergoing radical cystectomy with lymphadenectomy. Outcomes including pathologic downstaging to non-muscle invasive disease, pathologic complete response (defined as absence of disease -ypT0), overall- and cancer-specific- survival as well as time to recurrence were compared between cohorts A vs. B.ResultsA total of 219 patients treated at 14 different high-volume Institutions were included in this retrospective study. Patients who received 3 (cohort A) vs. 4 (cohort B) cycles of neoadjuvant cisplatin-gemcitabine were 160 (73,1%) vs. 59 (26,9%).At univariate analysis, the number of neoadjuvant cycles was not associated with either pathologic complete response, pathologic downstaging, time to recurrence, cancer specific, and overall survival. Of note, patients in cohort B vs. A showed a worse non-cancer specific overall survival at univariate analysis (HR= 2.53; 95 CI= 1.05 - 6.10; p=0.046), although this finding was not confirmed at multivariate analysis.ConclusionsOur findings suggest that 3 cycles of cisplatin-gemcitabine may be equally effective, with less long-term toxicity, compared to 4 cycles in the neoadjuvant setting.

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