Multicenter Evaluation of Neoadjuvant and Induction Gemcitabine-Carboplatin versus Gemcitabine-Cisplatin Followed by Radical Cystectomy for Muscle-Invasive Bladder Cancer

Sarah MH Einerhand, Anna J Black, Homayoun Zargar, Adrian S. Fairey, Colin P Dinney, Maria C Mir, Laura-Maria Krabbe, Michael S. Cookson, Niels-Erik Jacobson, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Wassim Kassouf, Marc A. Dall’Era, Srikala S. Sridhar, Jonathan S McGrath, Jonathan Aning, Shahrokh F Shariat, Jonathan L. WrightAndrew C. Thorpe, Todd M Morgan, Jeff M. Holzbeierlein, Trinity J Bivalacqua, Scott North, Daniel A. Barocas, Yair Lotan, Petros Grivas, Jorge A Garcia, Andrew J Stephenson, Jay B Shah, Simak Daneshmand, Kamran Zargar-Shoshtari, P. E. Spiess, Bas W van Rhijn, Peter C. Black, L. S. Mertens

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Abstract

PurposeCisplatin-based chemotherapy followed by radical cystectomy (RC) is recommended in patients with muscle-invasive bladder cancer (MIBC). However, up to 50% of patients are cisplatin-ineligible. The aim of this study was to compare clinical outcomes after ≥3 cycles of preoperative gemcitabine-carboplatin (gem-carbo) versus gemcitabine-cisplatin (gem-cis).  Methods We identified 1865 patients treated at 19 centers between 2000 and 2013. Patients were included if they had received ≥3 cycles of neoadjuvant (cT2-4aN0M0) or induction (cTanyN+M0) gem-carbo or gem-cis followed by RC. Results We included 747 patients treated with gem-carbo (n=147) or gem-cis (n=600). Patients treated with gem carbo had a higher Charlson Comorbidity Index (p=0.016) and more clinically node-positive disease (32% 88 versus 20%; p=0.013). The complete pathological response (pCR; ypT0N0) rate did not significantly differ between gem-carbo and gem-cis (20.7% versus 22.1%; p=0.73). Chemotherapeutic regimen was not significantly associated with pCR (OR: 0.99 [95%CI, 0.61-1.59]; p=0.96), overall survival (OS) (HR: 1.20 91 [95%CI, 0.85-1.67]; p=0.31), or cancer-specific survival (CSS) (HR: 1.35 [95%CI, 0.93-1.96]; p=0.11). Median  OS of patients treated with gem-carbo and gem-cis was 28.6 months (95%CI 18.1-39.1) and 45.1 months (95%CI 32.7-57.6)(p=0.18), respectively. Median CSS of patients treated with gem-carbo and gem-cis was 28.8 months (95%CI 9.8-47.8) and 71.0 months (95%CI median not reached)(p=0.02), respectively. Subanalyses of the neoadjuvant and induction setting did not show significant survival differences. 4 Conclusion Our results show that a subset of cisplatin-ineligible patients with MIBC achieve pCR on gem-carbo and that survival outcomes seem comparable to gem-cis provided patients are able to receive ≥3 cycles and undergo RC.
Original languageEnglish
JournalWorld Journal of Urology
DOIs
Publication statusPublished - 28 Sept 2022

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