Neoadjuvant chemotherapy in muscle invasive bladder cancer: Real world data on safety and outcome.

Abstract

e17036 Background: The standard treatment for Muscle Invasive bladder cancer (MIBC),Radical Cystectomy and Neoadjuvant chemotherapy (NACT) has shown to improve survival. Data from Indian population is scarce, and we sought to explore the efficacy, tolerability and factors affecting the outcome of Neoadjuvant chemotherapy in our population. Methods: This was a Retrospective Observational study conducted at a tertiary care centre. Patients of MIBC treated between 2008 and 2019 were included in the analysis. The NACT consisted of Gemcitabine + Cisplatin (GC) or Gemcitabine + Carboplatin (GCa). The prognostic significance of the various clinico-laboratory parameters was assessed by the log rank test. The survival analysis was done by the Kaplan Meier method. Results: Total of 40 patients received NACT from 2008-2019. The median age of study group was 62 years. Male to Female ratio was 5:1. Out of 40 patients, 26 were treated with GC and the remaining 14 received GCa. Majority (80%) patients were administered either 3 or 4 cycles of NACT. Among 18 patients who demonstrated good radiological response after NACT completion, 13 had received Cisplatin. After NACT, 32 (80%) underwent Radical Cystectomy and 3 were treated with CTRT. The remaining 5 did not receive definitive treatment. Pathological complete response (PCR) was achieved in 10 out of 32 patients (31%). Out of 10 patients with PCR, 9 belonged to Cisplatin group and only 1 in Carboplatin group. In patients with PCR, 80% remained progression free at last follow up. Grade 3/4 toxicities were minimal. However, achieving a pathological CR did not translate into significant survival benefit in our study (p value 0.10). Median follow up time and overall survival for the cohort was 29.5 and 54 months respectively. Conclusions: Gemcitabine/Cisplatin as NACT resulted in superior radiological response, PCR, PFS and OS when compared to Gemcitabine/Carboplatin in MIBC. This regimen is well tolerated and we advocate for further prospective studies with GC in this setting. [Table: see text]