University of Hertfordshire

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By the same authors

  • 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
  • Evan Y Yu
  • Evanguelos Xylinas
  • Wassim Kassouf
  • Marc A. Dall’Era
  • Srikala S. Sridhar
  • Jonathan S McGrath
  • Jonathan Aning
  • Shahrokh F Shariat
  • Jonathan L. Wright
  • Andrew 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
  • P. E. Spiess
  • Bas W van Rhijn
  • Peter C. Black
  • L. S. Mertens
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Original languageEnglish
JournalJournal of Urology
Publication statusSubmitted - 11 May 2022


Preoperative cisplatin-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 the present study was to compare pathological response and survival after at least three cycles of neoadjuvant or induction gemcitabine-carboplatin (gem-carbo) versus gemcitabine-cisplatin (gem-cis) followed by RC in a large, multicenter evaluation.

We identified 1865 patients with MIBC who were treated with chemotherapy followed by RC at 19 centers between 2000 and 2013. Patients were included if they had received at least three cycles of neoadjuvant (cT2-4aN0M0) or induction (cTanyN+M0) gem-carbo or gem-cis, followed by RC (n=747). Multivariable analyses were performed to determine factors predictive of pathological response at RC and survival.

Of the included patients, 147 were pre-treated with gem-carbo and 600 with gem-cis. Patients treated with gem-carbo were significantly older (67 vs 65 years; P<0.001), had a higher Charlson Comorbidity Index (P=0.016) and more often had clinically node-positive disease (32% vs 20%; p=0.013). The complete pathological response (pCR; ypT0N0) rate did not significantly differ after gem-carbo versus gem-cis (20.7% versus 22.1%; p=0.73). Median follow-up was 14.3 months. In multivariable analyses, chemotherapeutic regimen was not statistically significantly associated with pCR (OR: 0.99 [95%CI, 0.61-1.59]; p=0.96), overall survival (HR: 1.20 [95% CI, 0.85-1.67]; p=0.31), or cancer-specific survival (HR: 1.35 [95% CI, 0.93-1.96]; p=0.11). Subanalyses (neoadjuvant and induction setting) also did not show significant survival differences between patients treated with gem-carbo vs gem-cis.

Results from this multicenter study show that a subset of cisplatin-ineligible patients with MIBC achieve pathological response to gem-carbo at RC, and that survival outcomes seem comparable to gem-cis in the neoadjuvant and induction setting provided patients are able to receive at least three cycles and undergo RC.

ID: 27355301