802P - Efficacy and prognostic factors of neoadjuvant chemotherapy in resectable locally-advanced muscle-invasive bladder cancer (MIBC) patients (P) in an...

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Urothelial Cancers
Presenter Jose Luis Cuadra Urteaga
Authors J.L. Cuadra Urteaga1, M. Domenech2, P. Celiz1, J.J. Sánchez3, N. Pardo1, C. Buges1, J. Malet4, M. Arzoz5, J. Areal5, A. Font1
  • 1Medical Oncology, Catalan Institute of Oncology ICO Badalona Hospital Germans Trias i Pujol, Medical Oncology, 08916 - Badalona/ES
  • 2Oncology, ALthaia, Xarxa Assistencial de Manresa, 08243 - Manresa/ES
  • 3Statistics, Autonomous University of Madrid, 28029 - Madrid/ES
  • 4Urology, ALthaia, Xarxa Assistencial de Manresa, 08243 - Manresa/ES
  • 5Urology, Hospital Germans Trias i Pujol, 08916 - Badalona/ES

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 < 0.0001) were significant in the multivariate analysis.

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.