Comparison between neoadjuvant and adjuvant gemcitabine plus cisplatin chemotherapy for muscle‐invasive bladder cancer

Nobuaki Matsubara,Hirofumi Mukai,Kuniaki Itoh,Masahiko Nezu,Yoichi Naito

doi:10.1111/ajco.12017

Abstract

Aim: Radical cystectomy plus platinum-based perioperative chemotherapy is a standard treatment for patients with clinically localized muscle-invasive bladder cancer. The standard perioperative chemotherapy is methotrexate, vinblastine, doxorubicin and cisplatin (MVAC). However, no prospective randomized trial has been published that compares neoadjuvant and adjuvant chemotherapy for bladder cancer. Moreover, the efficacy of perioperative chemotherapy with gemcitabine plus cisplatin (GC) has not been clarified. In this study we have compared the clinical outcomes between neoadjuvant and adjuvant chemotherapy in patients receiving GC.Methods: We retrospectively reviewed the records of patients who were scheduled to be treated with a radical cystectomy plus perioperative chemotherapy with GC from 2005 to 2010 at our institution. The primary outcome measure was recurrence-free survival (RFS).Results: A total of 42 patients received perioperative chemotherapy with GC (25 neoadjuvant, 17 adjuvant). The median number of cycles of GC administered to the two groups was not significantly different. The median duration of follow up was 28.6 months. During the follow-up period, recurrence was observed in nine and three patients in the neoadjuvant and adjuvant groups, respectively. The RFS rate at median follow up was 67 and 76% in the neoadjuvant and adjuvant groups, respectively. No significant difference in RFS at median follow up was observed between the two groups (P = 0.124).Conclusion: Our results showed no statistically significant difference in RFS between neoadjuvant and adjuvant GC chemotherapy for muscle-invasive bladder cancer. We expect to validate these findings in a prospective randomized trial.

Highlights

Radical cystectomy with pelvic lymph-node dissection is a standard treatment option in patients with clinically localized muscle-invasive bladder cancer.[1,2] muscle-invasive bladder cancer has a high potential for systemic disease recurrence, which has been reported to occur in approximately 50% of patients during their clinical course, and cause their death in almost all of them.[3,4] Based on these observations, it is assumed that micrometastases already exist at the time of radical cystectomy
In order to test this hypothesis in this retrospective analysis, we reviewed and compared the outcomes, such as recurrence-free survival (RFS), in patients who received neoadjuvant or adjuvant gemcitabine plus cisplatin (GC) chemotherapy at our institution
The patients who received preceding radical cystectomy followed by adjuvant chemotherapy had a reason for choosing this sequence, such as symptoms with a hematuria necessitating a cystectomy prior to chemotherapy or muscle-invasion of bladder discovered in the cystectomy specimen

Summary

Introduction

Radical cystectomy with pelvic lymph-node dissection is a standard treatment option in patients with clinically localized muscle-invasive bladder cancer.[1,2] muscle-invasive bladder cancer has a high potential for systemic disease recurrence, which has been reported to occur in approximately 50% of patients during their clinical course, and cause their death in almost all of them.[3,4] Based on these observations, it is assumed that micrometastases already exist at the time of radical cystectomy. In order to avoid disease recurrence and death, many studies have tested the efficacy of perioperative systemic chemotherapy.[5,6,7,8]. The main rationale for early systemic chemotherapy (neoadjuvant) is to eradicate a micrometastasis and reduce the primary bladder tumor volume in order to facilitate the subsequent surgical procedure.

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Conclusion