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
Affiliations
- Matteo Ferro
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Ottavio de Cobelli
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Ottavio de Cobelli
- Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
- Gennaro Musi
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
- Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Daniela Pacella
- Department of Public Health, University of Naples Federico II, Naples, Italy
- Tommaso Muto
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
- Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy
- Francesco Del Giudice
- Department of Urology, Sapienza University of Rome, Rome, Italy
- Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Cittá della Salute e della Scienza, Torino School of Medicine, Turin, Italy
- Paolo Gontero
- Division of Urology, Department of Surgical Sciences, AOU Cittá della Salute e della Scienza, Torino School of Medicine, Turin, Italy
- Francesco Cantiello
- 0Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
- Rocco Damiano
- 0Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
- Fabio Crocerossa
- 0Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
- Abdal Rahman Abu Farhan
- 0Department of Urology, University of Catanzaro, UNIVERSITÁ “MAGNA GRÆCIA” di Catanzaro, Catanzaro, Italy
- Riccardo Autorino
- 1Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, United States
- Mihai Dorin Vartolomei
- 2Department of Urology, Vienna General Hospital, Vienna, Austria
- Mihai Dorin Vartolomei
- 3Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Tirgu Mures, Romania
- Matteo Muto
- 4Department of Hematology, Oncology and Radiotherapy Azienda ospedaliera San Giuseppe Moscati, Avellino, Avelino, Italy
- Michele Marchioni
- 5Department of Urology, G. D’Annunzio University of Chieti-Pescara, Chieti, Italy
- Andrea Mari
- 6Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
- Luca Scafuri
- 7Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Andrea Minervini
- 6Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi University Hospital, Florence, Italy
- Nicola Longo
- 8Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
- Francesco Chiancone
- 9Division of Urology, Hospital Antonio Cardarelli, Naples, Italy
- Sisto Perdona
- 0Division of Urology, Istituto Nazionale Tumori Fondazione G. Pascale (IRCCS), Naples, Italy
- Pietro De Placido
- 7Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Antonio Verde
- 7Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Michele Catellani
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Stefano Luzzago
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Francesco Alessandro Mistretta
- Division of Urology of European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Pasquale Ditonno
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
- Vincenzo Francesco Caputo
- 8Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
- Michele Battaglia
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
- Stefania Zamboni
- 1Department of Urology, Civil Hospital of Brescia, Brescia, Italy
- Alessandro Antonelli
- 1Department of Urology, Civil Hospital of Brescia, Brescia, Italy
- Alessandro Antonelli
- 2Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona - Polo Chirurgico Confortini - Borgo Trento, Verona, Italy
- Francesco Greco
- 3Department of Urology, Humanitas Gavazzeni, IRRCS, Bergamo, Italy
- Giorgio Ivan Russo
- 4Department of Urology, University of Catania, Catania, Italy
- Rodolfo Hurle
- 5Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
- Nicolae Crisan
- 6Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy, Ciuj Napoca, Romania
- Matteo Manfredi
- 7Urology Unit - Department of Oncology, School of Medicine, University of Turin, Turin, Italy
- Francesco Porpiglia
- 7Urology Unit - Department of Oncology, School of Medicine, University of Turin, Turin, Italy
- Giuseppe Di Lorenzo
- 8Department of Urology, Humanitas Research Hospital Milano, Milan, Italy
- Giuseppe Di Lorenzo
- 9Department of Medicine and Health Science, University of Molise, Campobasso, Italy
- Felice Crocetto
- 8Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
- Carlo Buonerba
- 0Rare Tumor Reference Center, Federico II University Hospital, Naples, Italy
- Carlo Buonerba
- 1Centro di Referenza Nazionale per l’Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy
- DOI
- https://doi.org/10.3389/fonc.2021.651745
- Journal volume & issue
-
Vol. 11
Abstract
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.
Keywords
- bladder cancer
- neoadjuvant chemotherapy
- radical cystectomy
- observational study
- cisplatin-based chemotherapy