Etiology of Treatment Delays in Patients Receiving Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer

2020 ◽  
Vol 6 (4) ◽  
pp. 435-444
Author(s):  
Ahmad M. El-Arabi ◽  
Syed M. Alam ◽  
Garth Sherman ◽  
William P. Parker ◽  
Jeffrey Thompson ◽  
...  

BACKGROUND: Neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) improves overall survival in muscle-invasive bladder cancer (MIBC), but successful completion rates of NAC are low. A retrospective analysis was undertaken to determine the etiology of deviations of NAC administration for MIBC. METHODS: We performed a retrospective review of MIBC patients in an institutional database who received NAC followed by RC from 2008 to 2016. Patients were characterized as having completed NAC without deviation (“No Deviation”) or with deviation (“Deviation”). Factors associated with “Deviation” were assessed with logistic regression models. RESULTS: 172 MIBC patients received NAC followed by RC; 49 were excluded due to incomplete NAC data. Of the remaining 123 patients, 80 (65%) received Gemcitabine and Cisplatin (GC) and 25 (20%) received dose-dense MVAC (ddMVAC). In all, 85 (69%) patients had “Deviation” in planned NAC administration, while the remaining 38 (31%) patients had “No Deviation.” Twenty-six (33%) of GC patients experienced delays (mean = 21.5±17.0 days) and 6 (24%) ddMVAC patients experienced delays (mean = 10.5±9.5 days). Receipt of GC was associated with higher likelihood of “Deviation” in comparison to ddMVAC (OR = 15.4; 95% CI 4.43–53.72, p < 0.01), and administration of NAC at our institution was associated with lower likelihood of “Deviation” in comparison to receipt in the community (OR = 0.25; 95% CI 0.25–0.72, p = 0.01). CONCLUSIONS: Deviations in administration of NAC were common in our cohort (69%) and were associated with receipt of GC and administration of NAC at an outside institution.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e16527-e16527
Author(s):  
George Tsironis ◽  
Roubini Zakopoulou ◽  
Konstantinos Koutsoukos ◽  
Kimon Tzanis ◽  
John Varkarakis ◽  
...  

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259526
Author(s):  
Artur Lemiński ◽  
Krystian Kaczmarek ◽  
Tomasz Byrski ◽  
Marcin Słojewski

Introduction Neoadjuvant chemotherapy has become standard of care for cisplatin-eligible patients with muscle-invasive bladder cancer qualified to radical cystectomy, providing a modest increase in 5-year overall survival rate. Several regimens are being employed for neoadjuvant treatment, largely because of their efficacy in metastatic setting. There is however a scarcity of evidence on the optimal cytotoxic regimen for neoadjuvant chemotherapy. Objectives We evaluated the efficacy of different protocols of neoadjuvant chemotherapy amongst patients who underwent radical cystectomy at our institution. Methods This is a single-center, retrospective, observational study including a cohort of 220 patients who underwent radical cystectomy between 2014 and 2020. The neoadjuvant chemotherapy cohort included 79 patients and was compared to the cohort of historical controls including 141 patients operated prior to routine administration of neoadjuvant chemotherapy and those who opted for upfront surgery. Results Administration of neoadjuvant chemotherapy decreased the risk of overall and cancer-specific mortality HR = 0.625 (95% CI 0.414–0.944), p = 0.025 and HR = 0.579 (95% CI 0.348–0.964), p = 0.036. Rates of downstaging, complete responses, lymph node metastasis, extravesical extension and positive surgical margins significantly favored neoadjuvant chemotherapy. Out of cytotoxic regimens, dose-dense MVAC and gemcitabine-cisplatin were similarly efficacious providing 46.9% and 50% of downstaging to <ypT2N0 respectively, including 30.6% and 25% of complete remissions. However, only dose-dense MVAC was associated with reduction of all-cause and cancer specific mortality risk HR = 0.385 (95% CI 0.214–0.691) p = 0.001 and HR = 0.336 (95% CI 0.160–0.703), p = 0.004 respectively. Conclusions Our study implies that neoadjuvant chemotherapy with subsequent radical cystectomy provides significant improvement over upfront surgery in locoregional control and long-term prognosis of muscle-invasive bladder cancer. The urologic community should strive to maximize utilization of neoadjuvant chemotherapy, yet further research, including randomized control trials, is needed to validate superiority of dose-dense MVAC as the preferred regimen for cisplatin-eligible patients.


2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Ahmad El-Arabi* ◽  
Garth Sherman ◽  
Jeffrey Holzbeierlein ◽  
Eugene Lee ◽  
Elizabeth Wulff-Burchfield

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2770
Author(s):  
Doo Yong Chung ◽  
Dong Hyuk Kang ◽  
Jong Won Kim ◽  
Jee Soo Ha ◽  
Do Kyung Kim ◽  
...  

Platinum-based neoadjuvant chemotherapy (NAC) is widely used for treating muscle-invasive bladder cancer (MIBC). A systematic review was performed following PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched up to December 2020. We conducted a meta-analysis to compare the oncologic outcomes of ddMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) and GC (gemcitabine and cisplatin), which are the most widely used NAC regimens. Endpoints included pathologic complete response (pCR), pathologic downstaging (pDS), overall survival (OS), and cancer-specific survival (CSS). Five studies, with a total of 1206 patients, were included for meta-analysis. pCR was observed in 35.2% of the ddMVAC arm and in 25.1% of the GC arm, and pCR was significantly higher in ddMVAC than in GC (odds ratio (OR), 1.45; 95% confidence interval (CI), 1.11–1.89; p = 0.006). There was no significant difference in pDS (OR, 1.37; CI, 0.84–2.21; p = 0.20). OS was significantly higher in ddMVAC than in GC (hazard ratio, 2.16; CI, 1.42–3.29; p = 0.0004). Only one study reported CSS outcomes. The results of this analysis indicate that ddMVAC is superior to GC in terms of pCR and OS, suggesting that ddMVAC is more effective than GC in NAC for MIBC. However, this should be interpreted with caution because of the inherent limitations of retrospective studies.


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