Atreya Dash was supported by a gift from the Tina and Richard V. Carolan Foundation.
A role for neoadjuvant gemcitabine plus cisplatin in muscle-invasive urothelial carcinoma of the bladder†‡
A retrospective experience
Article first published online: 29 SEP 2008
Copyright © 2008 American Cancer Society
Volume 113, Issue 9, pages 2471–2477, 1 November 2008
How to Cite
Dash, A., Pettus, J. A., Herr, H. W., Bochner, B. H., Dalbagni, G., Donat, S. M., Russo, P., Boyle, M. G., Milowsky, M. I. and Bajorin, D. F. (2008), A role for neoadjuvant gemcitabine plus cisplatin in muscle-invasive urothelial carcinoma of the bladder. Cancer, 113: 2471–2477. doi: 10.1002/cncr.23848
See editorial on pages 2379–81, this issue.
Presented in part at the American Society of Clinical Oncology Annual Meeting, Chicago, Illinois, May 30-June 3, 2008.
- Issue published online: 17 OCT 2008
- Article first published online: 29 SEP 2008
- Manuscript Accepted: 8 APR 2008
- Manuscript Revised: 21 MAR 2008
- Manuscript Received: 7 FEB 2008
- urothelial carcinoma;
- radical cystectomy
Neoadjuvant cisplatin-based chemotherapy improves survival in muscle-invasive urothelial cancer, with MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) considered the standard regimen. Gemcitabine plus cisplatin (GC) has similar efficacy and less toxicity than MVAC in metastatic disease, but is untested as neoadjuvant treatment.
The authors retrospectively evaluated patients with muscle-invasive urothelial carcinoma who received neoadjuvant GC before radical cystectomy between November 2000 and December 2006 at Memorial Sloan-Kettering Cancer Center. Post-therapy pathological downstaging to either residual disease at cystectomy (pT0) or no residual muscle-invasion (<pT2, ie, pT0, pTIS, pT1), chemotherapy delivery, and disease-free survival were the endpoints of interest. For comparison, similar endpoints were assessed in a historical cohort treated with neoadjuvant MVAC.
Four cycles of neoadjuvant GC were given over 12 weeks (n = 42). Thirty-nine (93%) of 42 patients received 4 cycles, with a median 91% drug delivery for cisplatin and 90% for gemcitabine. The pT0 proportion was 26% (95% confidence interval [CI], 14-42), and no residual muscle-invasive disease proportion (<pT2) was 36% (95% CI, 21-52); pT0 was achieved in 28% (95% CI, 16-42) and <pT2 in 35% (95% CI, 23-49) of 54 MVAC-treated patients. All 15 GC patients achieving <pT2 pathologic stage remained disease-free at a median follow-up of 30 months.
Neoadjuvant GC is feasible and allows for timely drug delivery. The proportion of GC-treated patients whose primary tumors were downstaged, with prolonged disease-free survival and minimal or no residual disease, was similar to MVAC-treated patients. Cancer 2008. © 2008 American Cancer Society.