Abstract 282P
Background
The primary objective of this study is to compare the pathological complete response (pCR) rates between non-metastatic muscle-invasive bladder cancer (MIBC) patients who received neoadjuvant chemotherapy (NAC) using ddMVAC (dose-dense methotrexate, vinblastine, adriamycin, and cisplatin) and GC (gemcitabine and cisplatin) prior to radical cystectomy (RC) versus those who underwent RC alone. Secondary endpoints include the comparison of pT0-1N0 rates, tumor downstaging, hospital length of stay, side effects of NAC, progression-free survival (PFS), and overall survival (OS).
Methods
This retrospective study screened 1,918 patients diagnosed with bladder cancer from January 1, 2010, to December 31, 2023. A total of 176 patients with MIBC, clinical stage T2-4, N0-3, M0, were included and divided into 3 groups: ddMVAC, GC, and upfront RC (23, 21, and 132 patients respectively). Data were collected from past medical records and analyzed using SPSS software version 29.
Results
The rates of pCR and pT0-1N0 were higher in patients treated with ddMVAC and GC compared to those undergoing RC alone (pCR: 36.4% and 30% vs. 12.9%; pT0-1N0: 50% and 35% vs. 15.9%), with statistical significance noted in the ddMVAC group (p = 0.011 for pCR; p < 0.001 for pT0-1N0). Tumor downstaging was more effectively achieved in the ddMVAC and GC groups compared to the RC alone group (p = 0.003). Operative time was similar across all groups (p > 0.05). Hospital stay was shorter for patients receiving GC compared to those undergoing RC alone (13 vs. 17 days; p = 0.039). DD-MVAC was associated with a lower incidence of neutropenia than GC (21.7% vs. 71.4%, p < 0.001), other side effects were similar between the two groups (p > 0.05). There were no significant differences in PFS and OS among the groups (p > 0.05).
Conclusions
Neoadjuvant chemotherapy with ddMVAC and GC resulted in higher pCR and pT0-1N0 rates compared to RC alone, with statistically significant improvements noted with ddMVAC. DDMVAC and GC also enhanced tumor downstaging and reduced hospital stays compared to RC alone. DD-MVAC showed a lower rate of neutropenia compared to GC. No significant differences in PFS and OS were observed among the groups.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.