Research output: Contribution to journal › Article › peer-review
Multicenter Evaluation of Neoadjuvant and Induction Gemcitabine-Carboplatin versus Gemcitabine-Cisplatin Followed by Radical Cystectomy for Muscle-Invasive Bladder Cancer. / Einerhand, Sarah MH; Black, Anna J; Zargar, Homayoun; Fairey, Adrian S.; Dinney, Colin P; Mir, Maria C; Krabbe, Laura-Maria; Cookson, Michael S.; Jacobson, Niels-Erik; Montgomery, Jeffrey S; Vasdev, Nikhil; Yu, Evan Y; Xylinas, Evanguelos; Kassouf, Wassim; Dall’Era, Marc A.; Sridhar, Srikala S.; McGrath, Jonathan S; Aning, Jonathan; Shariat, Shahrokh F; Wright, Jonathan L.; Thorpe, Andrew C.; Morgan, Todd M; Holzbeierlein, Jeff M.; Bivalacqua, Trinity J; North, Scott; Barocas, Daniel A.; Lotan, Yair; Grivas, Petros; Garcia, Jorge A; Stephenson, Andrew J; Shah, Jay B; Daneshmand, Simak; Spiess, P. E.; van Rhijn, Bas W; Black, Peter C.; Mertens, L. S.
In: Journal of Urology, 11.05.2022.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Multicenter Evaluation of Neoadjuvant and Induction Gemcitabine-Carboplatin versus Gemcitabine-Cisplatin Followed by Radical Cystectomy for Muscle-Invasive Bladder Cancer
AU - Einerhand, Sarah MH
AU - Black, Anna J
AU - Zargar, Homayoun
AU - Fairey, Adrian S.
AU - Dinney, Colin P
AU - Mir, Maria C
AU - Krabbe, Laura-Maria
AU - Cookson, Michael S.
AU - Jacobson, Niels-Erik
AU - Montgomery, Jeffrey S
AU - Vasdev, Nikhil
AU - Yu, Evan Y
AU - Xylinas, Evanguelos
AU - Kassouf, Wassim
AU - Dall’Era, Marc A.
AU - Sridhar, Srikala S.
AU - McGrath, Jonathan S
AU - Aning, Jonathan
AU - Shariat, Shahrokh F
AU - Wright, Jonathan L.
AU - Thorpe, Andrew C.
AU - Morgan, Todd M
AU - Holzbeierlein, Jeff M.
AU - Bivalacqua, Trinity J
AU - North, Scott
AU - Barocas, Daniel A.
AU - Lotan, Yair
AU - Grivas, Petros
AU - Garcia, Jorge A
AU - Stephenson, Andrew J
AU - Shah, Jay B
AU - Daneshmand, Simak
AU - Spiess, P. E.
AU - van Rhijn, Bas W
AU - Black, Peter C.
AU - Mertens, L. S.
PY - 2022/5/11
Y1 - 2022/5/11
N2 - Background 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. Methods 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. Results 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.Conclusion 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.
AB - Background 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. Methods 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. Results 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.Conclusion 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.
M3 - Article
JO - Journal of Urology
JF - Journal of Urology
ER -