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Tolerability and efficacy of neoadjuvant chemotherapy with three-weekly interval methotrexate, doxorubicin, vinblastine and cisplatin regimen for patients with locally advanced bladder cancer

Date

19 Dec 2015

Session

Poster presentation 1

Presenters

Satoko Arai

Citation

Annals of Oncology (2015) 26 (suppl_9): 71-79. 10.1093/annonc/mdv524

Authors

S. Arai1, T. Hara2, H. Hashimoto3, Y. Shinoda2, M. Komiyama2, T. Otsuka3, H. Fujimoto2, Y. Hayashi3

Author affiliations

  • 1 Pharmacy, National Cancer Center Hospital, 104-0045 - Tokyo/JP
  • 2 Urology, National Cancer Center Hospital, Tokyo/JP
  • 3 Pharmacy, National Cancer Center Hospital, Tokyo/JP
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Aim/Background

Neoadjuvant chemotherapy (NAC) with methotrexate (MTX), doxorubicin (DXR), vinblastine (VBL) and cisplatin (CDDP) (MVAC) for patients with muscle-invasive bladder cancer demonstrates survival benefits. Common causes for dose adjustments of MVAC are leukopenia, thrombocytopenia, and mucositis, and most adjustments occur on day 15 for MTX and VBL. We investigated the tolerability and efficacy of cases medicated by neoadjuvant modified three-weekly MVAC (m-MVAC) which omit the treatment on day 22.

Methods

We analyzed twenty-five patients with locally advanced bladder cancer (UICC 2009 clinical stage T1-4N0-3M0) medicated by neoadjuvant m-MVAC (MTX 30mg/m2 on day 1; VBL 3mg/m2, DXR 30mg/m2 and CDDP 70mg/m2 on days 2) between May 2007 and February 2014. We looked at efficacy, grade of adverse events (CTCAE ver4.0), relative dose intensity (RDI) and surgery implementation rates for neoadjuvant m-MVAC.

Results

The median age was 62 (37 to 77), and the number of male patients was 24. The median duration and range of follow-up were 1580 and 242-2868 days. Numbers of patients for each clinical stages were 1 (4%), 12 (48%), 1 (4%) and 11 (44%) in stage 1, 2, 3 and 4, respectively. Numbers of patients who received of neoadjuvant m-MVAC for each courses were 1 (4%), 18 (72%), 2 (8%) and 4 (16%) in received 1, 2, 3 and 4 courses, respectively. The RDI was 0.95 in total cases, and RDIs for each courses were 1.00, 0.98, 0.83 and 0.86 for 1, 2, 3 and 4 courses. The surgery implementation rate was 100%. As grade 3 to 4 adverse events, neutropenia occurred in 4 patients (16%), and febrile neutropenia, anemia and hiccup occurred in 1 patient (4%). Three patients (12%) received G-CSF at least once and 2 patients (8%) had emergency hospitalizations due to fever and hematuria. In total cases, 3-year overall (OS) and recurrence-free survival (RFS) rates were 0.79 (95% CI: 0.56-0.91) and 0.75 (95% CI: 0.52-0.88), respectively. In clinical stage 2 or 3 patients, 3-year OS and RFS were 0.84 (95% CI: 0.49-0.96).

Conclusions

Our study supports the tolerability and efficacy of neoadjuvant three-weekly m-MVAC for the patients with locally advanced bladder cancer.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.

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