528 CARBOPLATIN-BASED NEOADJUVANT CHEMOTHERAPY: A REASONABLE ALTERNATIVE FOR CISPLATIN UNFIT PATIENTS?

Abstract

You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2012528 CARBOPLATIN-BASED NEOADJUVANT CHEMOTHERAPY: A REASONABLE ALTERNATIVE FOR CISPLATIN UNFIT PATIENTS? Laura Mertens, Richard Meijer, Bas van Rhijn, Andries Bergman, Martijn Kerst, and Simon Horenblas Laura MertensLaura Mertens Amsterdam, Netherlands More articles by this author , Richard MeijerRichard Meijer Amsterdam, Netherlands More articles by this author , Bas van RhijnBas van Rhijn Amsterdam, Netherlands More articles by this author , Andries BergmanAndries Bergman Amsterdam, Netherlands More articles by this author , Martijn KerstMartijn Kerst Amsterdam, Netherlands More articles by this author , and Simon HorenblasSimon Horenblas Amsterdam, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.601AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Carboplatin has not been investigated as alternative to cisplatin-based regimens in the neoadjuvant setting. We investigated the feasibility of neoadjuvant carboplatin-based chemotherapy in patients with non-organ confined urothelial carcinoma (UC) who are considered unfit for cisplatin. We analyzed the clinical and pathological response and survival of patients who were treated with a neoadjuvant combination of gemcitabine and carboplatin (Gem/Carbo). A comparison was made to patients who received neoadjuvant MVAC. METHODS We identified 152 patients (mean age: 59.9±9.4 years) with non-organ confined UC (T3-T4a and/or N+), who received neoadjuvant MVAC (n=111) or Gem/Carbo (n=41) at our hospital, between 2001-2011. One hundred and fourteen patients completed four cycles of MVAC or Gem/Carbo. Clinical post-chemotherapy status (ycTNM) was evaluated according to RECIST 1.1. A radical cystectomy (RC) and bilateral extended pelvic lymph node dissection (ePLND) was performed in 98 patients (MVAC: 75, Gem/Carbo: 23). Pathological complete response (pCR) was defined as no evidence of disease (ypT0N0); partial response as any downstaging from the baseline. Recurrence free survival (RFS) and overall survival (OS) were analysed using the Kaplan-Meier method. A multivariable analysis was performed. RESULTS Both groups had comparable baseline tumour characteristics. Complete clinical response rates did not differ significantly among the treatment groups. Moreover, pCR was found in the specimens of 25 patients (33.3%) in the MVAC group versus 7 (30,4%) in the Gem/Carbo group (P=0.795). Any downstaging from the baseline was seen in 70.7% (MVAC) versus 60.9% (GemCarbo) (P=0.444). RFS did not significantly differ between both treatment groups (log-rank, P = 0.715). Median OS was 22.0±8.4 months among patients in the MVAC group and 22.0±4.5 months among patients in the Gem/Carbo group. (log-rank, P = 0.328). In the multivariate analysis, pCR was the only variable with a significant influence on clinical outcome (P<0.05). CONCLUSIONS Neoadjuvant Gem/Carbo for non-organ confined UC achieves comparable clinical and pathological response rates as well as overall survival to the MVAC schemes. Our data suggest that a carboplatin-based regimen can be considered a reasonable alternative for cisplatin unfit patients in the neoadjuvant setting. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e217 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Mertens Amsterdam, Netherlands More articles by this author Richard Meijer Amsterdam, Netherlands More articles by this author Bas van Rhijn Amsterdam, Netherlands More articles by this author Andries Bergman Amsterdam, Netherlands More articles by this author Martijn Kerst Amsterdam, Netherlands More articles by this author Simon Horenblas Amsterdam, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...