802P - Efficacy and Prognostic Factors of Neoadjuvant Chemotherapy in Resectable Locally-Advanced Muscle-Invasive Bladder Cancer (MIBC) Patients (P) in an Off-Protocol Clinical Setting

Abstract

ABSTRACT Introduction Although neoadjuvant chemotherapy is a recommended treatment in MIBC, it has not gained widespread acceptance in clinical practice, due to the lack of predictive markers of efficacy and the absence of a standard chemotherapy regimen. Furthermore, since few studies have assessed the role of neoadjuvant chemotherapy in an off-protocol setting, there may be doubts about its feasibility. Material and methods We retrospectively analyzed 124 p with MIBC treated with neoadjuvant cisplatin-based chemotherapy at two centers from 1991 to 2010. Clinical and pathological variables were correlated with survival. All patients were classified as stage cT2-4N0M0 based on TUR (trans-urethral resection) and CT scan findings and were candidates for neoadjuvant chemotherapy followed by cystectomy. Results 10 p (8%) were cT2N0, 83 p (66%) cT3N0, and 31 p (26%) cT4aN0. 60 p (48%) were treated with CMV (cisplatin, methotrexate and vinblastine) and 64 p (52%) with cisplatin/gemcitabine (CG). One patient died from treatment-related toxicity. A complete resection was performed in 109 p (87%). A significant pathological response (pR) (pT0-1) was obtained in 60 p (48%). Median survival (MS) and 5-year (5y) survival were 59 months (m) and 50%, respectively. Median cancer-specific survival (CSS) was not reached and 5y CSS was 64%. 5y overall survival was similar (50.3% vs 50.9%) in p treated with CMV or CG. In p with a significant pR, 5y survival was 77%, while for p who did not respond to chemotherapy (pT3-4NO or N+), it was 8.3%. Only complete resection (HR:3.36, P = 0.006) and lymphovascular invasion (LVI) (HR:17.29, P Conclusions Neoadjuvant chemotherapy followed by cystectomy is feasible in p with locally-advanced MIBC. Both CMV and CG are active regimens, with 5-y survival that compares favorably with surgery alone. p responding to neoadjuvant chemotherapy have an excellent prognosis, while those who do not respond should be considered for non-cross-resistant adjuvant chemotherapy. Disclosure All authors have declared no conflicts of interest.