The baseline neutrophil-to-lymphocyte ratio is a validated marker for a poor prognosis. Multiple assessments of the pre-treatment neutrophil-to-lymphocyte ratio might be required. Reduction in the neutrophil-to-lymphocyte ratio during chemotherapy may be associated with improved survival.
e15016 Background: Neoadjuvant chemotherapy (NAC) with MVAC has been shown to improve overall survival in patients with muscle invasive transitional cell carcinoma of the bladder (MIBC), with pathological complete response (pCR) correlating with a survival benefit. Despite the lack of randomized data for cisplatin/gemcitabine (GC) in the neoadjuvant setting, it is commonly used in clinical practice, given its favorable toxicity profile and comparable efficacy to MVAC in the context of metastatic disease. Methods: Data was retrospectively obtained on 93 patients with T2-T4, N0-2 M0 MIBC treated with curative intent in our institution between 2005-2011. Characteristics of patients treated with GC NAC, along with treatment tolerance and outcomes, were collected. Results: Of 93 patients, 27% (n=25) were treated with GC NAC. Median age was 66 (range 49-81). 88% (n=22) of patients were clinical stage T3/4 and/or N1/2. 68% of patients received 28-day cycles of GC, with 32% receiving 21-day cycles of GC. One patient had split cisplatin dosing. 91% and 82% of planned cisplatin and gemcitabine were delivered, respectively. There were no treatment-related deaths. On completion of NAC, 52% (n=13) of patients underwent radical cystectomy, of whom 38% (n=5) achieved a pCR, and 62% (n=8) were downstaged to non-muscle invasive bladder cancer (nMIBC). Definitive chemoradiotherapy was used in 20% (n=5) of patients, whilst 12% (n=3) had no radical treatment due to progressive disease (n=2), or to a decline in ECOG performance status (n=1). Amongst patients without radical cystectomy, 12% (n=3) of patients achieved a biopsy-proven clinical complete response (cCR). In the intent-to-treat population, median disease-free survival was 32 months, and median overall survival 38.8 months. All patients with a pCR, cCR, or downstaging to nMIBC (n=12), were alive at a median follow-up of 16 months (3.9 – 49.1 months), although 1 patient had relapsed. Conclusions: GC is a well-tolerated regimen in the neoadjuvant treatment of MIBC, with a pCR rate comparable to that reported with MVAC. Our findings support the use of GC in the neoadjuvant treatment of MIBC.
306 Background: Pancreatic cancer is known to be aggressive and treatment-resistant. In potentially resectable PC, time from diagnostic imaging to surgery correlates with rates of metastases at laparatomy. In advanced PC, therapeutic benefits of ctx are frequently calculated from start of treatment. In view of its aggressiveness, we investigated if the interval between dx and commencement of ctx influences overall survival (OS) in patients (pts) with advanced PC. Methods: Pts with PC were identified from 4 insitutional databases. Inclusion criteria were unresectable (UPC) or metastatic disease (MPC) and receipt of ctx. Clinicopathologic details were collected. Intervals from histologic dx to ctx were calculated. Analyses were based on receipt of ctx within or after 2 weeks (w), 4w and 6w of dx. OS was presented as hazard ratio (HR) with associated p-value. Results: 212 pts were identified. Median age was 63 years (range: 33 – 83) and 58% were males. 60% of pts had MPC and 24% received doublet ctx. Median number of days from dx to ctx was 24 days (range: 2 – 202). For UPC and MPC, 20 and 31% of pts began ctx within 2w (p=0.08), 48 and 63% within 4w (p=0.03) and 73 and 82% within 6w (p=0.13), respectively. OS for the entire cohort, UPC and MPC were comparable whether ctx was commenced within pre-defined intervals or not (see table). A subgroup of pts treated with doublet ctx was examined. No OS difference was seen when treated within defined time points (HR 1.1, 1.0, 1.5; p=0.76, 0.96, 0.43). For 77% of MPC with hepatic metastases, no improvement in OS in relation to time interval was noted (HR 1.5, 1.0, 1.1; p=0.10, 0.90, 0.85). For 21% of MPC with ≥2 metastatic sites, ctx within 4w and 6w might improve OS but significance was not reached (HR 0.65, 0.61; p=0.43, 0.46). Conclusions: Commencement of ctx for PC could be delayed due pts-, disease- or infrastructural factors. Our data did not suggest a detrimental effect on OS from ctx delay. However, the lack of survival benefit from early ctx might be due to less effective ctx or inherent aggressiveness of the disease. [Table: see text]
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.