Early outcomes with neoadjuvant high-dose intensity methotrexate, vinblastine, doxorubicin, and cisplatin (HD-MVAC) or gemcitabine and cisplatin (GC) in muscle-invasive urothelial carcinoma of the bladder: A single-institution experience.

280 Background: Compared to MVAC, HD-MVAC achieves significantly higher complete response rates in patients (pts) with metastatic bladder cancer. Based on current literature, 7%-38% of pts with muscle-invasive bladder cancer achieve pathological down-staging (pT0) with neoadjuvant chemotherapy (NC), which correlates with improved disease-free and overall survival. The role of HD-MVAC has not been evaluated in the neoadjuvant setting. In this retrospective study, we present our data in pts who received NC with HD-MVAC or GC followed by radical cystectomy (RC). Methods: From July 2008 to August 2010, 38 (pts) received 4 cycles of NC with either HD-MVAC or GC for at least T2 bladder cancer followed by RC. The endpoints of interest of this study were the complete pathologic response (pT0) or down-staging to < pT2 (pT0, pTis, and pT1) at RC; and median interval to RC from the time of diagnosis of muscle-invasive bladder cancer and start of NC. Results: Median age at the time of diagnosis was 66 years (35-80 years). Fifteen pts received neoadjuvant HD-MVAC, and 23 received neoadjuvant GC. Clinical T stage at the time of diagnosis was T2 in 29 (76%), T3 in 3 (8%), and T4 in 6 (16%) pts. Down-staging to < pT2 was achieved in 8 (53%) of HD-MVAC pts and 10 (43%) of GC pts. pT0 was achieved in 5 (33%) of HD-MVAC pts and 9 (39%) of GC pts. The median interval from time of diagnosis to RC was 129 days (range 84-154) for the HD-MVAC pts, and 145 days (range 108-252) for the GC pts. The median interval from initiation of NC to RC was 85 days (range 53-122) for the HD-MVAC pts and 107 days (range 60-126) for the GC pts. Overall, NC was well tolerated with 80% of HD-MVAC pts and 78% of GC pts completing the planned chemotherapy. To this date, none of the pT0 pts had recurrence. Conclusions: Both neoadjuvant HD-MVAC and GC appear to be well tolerated, with very promising rate of pathological down-staging. Longer follow-up is needed for the survival outcomes of these patients. A shorter interval from diagnosis and initiation of NC to RC might be responsible for our better outcomes comparing to some historical data. No significant financial relationships to disclose.

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Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

Canadian Urological Association Journal ◽

10.5489/cuaj.1643 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 287 ◽

Cited By ~ 7

Author(s):

Faraj El-Gehani ◽

Scott North ◽

Sunita Ghosh ◽

Peter Venner

Keyword(s):

Neoadjuvant Chemotherapy ◽

Urothelial Carcinoma ◽

Clinical Stage ◽

Retrospective Chart Review ◽

Cancer Specific Survival ◽

Risk Of Death ◽

Lower Stage ◽

Carcinoma Of The Bladder ◽

Muscle Invasive ◽

Gemcitabine And Cisplatin

Introduction: Neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy (RC) for muscle invasive urothelial carcinoma of the bladder improves survival. This study was undertaken to determine the rate of neoadjuvant gemcitabine and cisplatin use prior to RC and to assess its effect on the pathologic response rates and cancer-specific survival (CSS) and overall survival (OS).Methods: This retrospective chart review examined all patients having a RC between January 1, 2007 and June 30, 2011. We collected patient demographics, pre-treatment clinical stage, type of chemotherapy, post-RC pathologic data and survival data.Results: A total of 251 RC were performed of which 160 were for stage cT2-T4 urothelial carcinoma of the bladder. Of the 160 patients, 91 (57%) received neoadjuvant gemcitabine and cisplatin (GC) and 69 (43%) went straight to RC. Patients receiving neoadjuvant GC had a greater chance of achieving a pathologically lower stage compared to the untreated population: pT0 at 21% vs. 3%; non-invasive cancer at 37% vs. 10%; and organ-confined cancer at 60% vs. 33% (p < 0.001). Survival correlated with pathological stage: ≤pT3a patients had a median OS and CSS of 48.8 and 51.2 months compared to an OS and a CSS in ≥pT3b patients of 21.8 and 28.1 months, respectively (p < 0.0001).Conclusions: Neoadjuvant chemotherapy for urothelial carcinoma of the bladder is more frequently administered at our institution compared to the published literature. We have found that neoadjuvant chemotherapy increases the rate of down-staging, which is associated with a reduced the risk of death from urothelial carcinoma of the bladder.

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Comparison of Clinical Outcomes in Patients With Localized or Locally Advanced Urothelial Carcinoma Treated With Neoadjuvant Chemotherapy Involving Gemcitabine-Cisplatin and High Dose-Intensity MVAC

10.21203/rs.3.rs-164451/v1 ◽

2021 ◽

Author(s):

Yongjune Lee ◽

Young Seok Kim ◽

Bumsik Hong ◽

Yong Mee Cho ◽

Jae-Lyun Lee

Keyword(s):

Neoadjuvant Chemotherapy ◽

Medical Center ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Disease Free Survival ◽

Dose Intensity ◽

Complete Response ◽

High Dose ◽

Muscle Invasive ◽

High Dose Intensity

Abstract PurposeTo compare the efficacy and safety of high dose-intensity combination of methotrexate, vinblastine, adriamycin and cisplatin (HD MVAC) with gemcitabine plus cisplatin (GC) as a neoadjuvant chemotherapy (NAC) in muscle-invasive bladder cancer (MIBC) or locally advanced upper tract urothelial cancer (UTUC). Patients and MethodsA retrospective analysis was conducted for patients with UC (cT2-4aN0-1M0) who received NAC from January 2011 and December 2017 at Asan Medical Center. Pathologic complete response (pCR), down-staging (<ypT2 and no N upstaging), disease-free survival (DFS), OS and safety were compared for each regimen. ResultsOut of a total of 277 patients, 176 patients received GC and 41 patients received HD MVAC. With the exception of age (patients receiving GC were younger; p=0.002), other baseline characteristics were well balanced between groups. pCR rates were 27.0% for GC and 22.6% for HD MVAC (p=0.62), and down-staging rate was 50.8% for GC and 58.1% for HD MVAC (p=0.47). There were no differences in OS (72.1% vs 73.1% for GC vs HD MVAC; p=0.58) and DFS (54.9% vs 63.3% for GC vs HD MVAC; p=0.21) at 3 years. HD MVAC with prophylactic G-CSF was associated with a higher incidence of febrile neutropenia (p<0.001) than GC. The NAC regimen was not an independent prognostic factor for OS. ConclusionsOncologic outcomes were not significantly different between the GC and HD MVAC when used as NAC in MIBC/UTUC.

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High-dose intensity-modulated radiation therapy as primary treatment of prostate cancer: genitourinary/gastrointestinal toxicity and outcomes, a single-institution experience

La radiologia medica ◽

10.1007/s11547-018-0977-1 ◽

2019 ◽

Vol 124 (5) ◽

pp. 422-431 ◽

Cited By ~ 1

Author(s):

Beatrice Detti ◽

Muhammed Baki ◽

Carlotta Becherini ◽

Calogero Saieva ◽

Daniele Scartoni ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Intensity Modulated Radiation Therapy ◽

Dose Intensity ◽

Primary Treatment ◽

Gastrointestinal Toxicity ◽

High Dose ◽

Single Institution ◽

Intensity Modulated ◽

High Dose Intensity

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High-dose intensity systemic therapy of metastatic bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1987.5.3.450 ◽

1987 ◽

Vol 5 (3) ◽

pp. 450-455 ◽

Cited By ~ 12

Author(s):

W J Hrushesky ◽

R V Roemeling ◽

P A Wood ◽

T R Langevin ◽

P Lange ◽

...

Keyword(s):

Bladder Cancer ◽

Combination Chemotherapy ◽

Systemic Therapy ◽

Metastatic Cancer ◽

Transitional Cell ◽

Dose Intensity ◽

High Dose ◽

Complete Disappearance ◽

Carcinoma Of The Bladder ◽

High Dose Intensity

Forty-three consecutively diagnosed patients with widely metastatic transitional cell carcinoma of the bladder (TCCB) were treated with a high-dose intensity, chronobiologically timed combination of doxorubicin and cisplatin, followed by Cytoxan (Mead Johnson Pharmaceuticals, Evansville, IN), 5-fluorouracil (5-FU), and cisplatin maintenance for up to 2 years. Fifty-seven percent of the 35 evaluable patients with widespread metastatic cancer responded objectively. Twenty-three percent had complete disappearance of all cancer. Median survival from first treatment for complete responders (CRs) was more than 2 years, and 1 year for partial responders (PRs). Three of the CRs were alive without evidence of cancer more than 2 years after stopping all therapy. High-dose intensity combination chemotherapy can induce durable CRs of widespread bladder cancer.

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