Carboplatin Based Induction Chemotherapy for Nonorgan Confined Bladder Cancer—A Reasonable Alternative for Cisplatin Unfit Patients?

Mertens, Laura S.; Meijer, Richard P.; Kerst, J. Martijn; Bergman, Andries M.; Horenblas, Simon

doi:10.1016/j.juro.2012.06.018

Cited by 39 publications

(18 citation statements)

References 21 publications

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“…It is important to recognize such subgroups because study findings may be influenced by these; however, even if the four patients who had clinically progressive disease are considered to have pathologically tumour‐positive LNs, the difference in incidence of occult LN metastases between the NAC and the non‐NAC group among the patients with cT3–4 disease, remains significant (NAC: 26.0% vs non‐NAC: 40.7%, P = 0.012). Another weakness was the use of three different chemotherapeutic regimens; however, a previous report from our group showed similar pathological response rates .…”

Section: Discussionmentioning

confidence: 78%

“…, or gemcitabine/cisplatin (gemcitabine 1000–1250 mg/m 2 and cisplatin 70 mg/m 2 on day 1 in 4 h, gemcitabine 1000 mg/m 2 on day 8 in 30 min) in a 21‐day cycle. Patients who were considered unfit for cisplatin were selected to receive carboplatin‐based combination chemotherapy; gemcitabine/carboplatin . Selection criteria correspond to those described by Galsky et al.…”

Section: Methodsmentioning

confidence: 99%

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Occult lymph node metastases in patients with carcinoma invading bladder muscle: incidence after neoadjuvant chemotherapy and cystectomy vs after cystectomy alone

et al. 2014

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Objective• To investigate the effect of neoadjuvant chemotherapy (NAC) on the incidence of lymph node (LN) metastases in clinically node-negative (cN0) patients with carcinoma invading the bladder muscle (MIBC). Patients and Methods• Between 1990 and 2012, 828 consecutive patients underwent radical cystectomy (RC) with extended pelvic LN dissection (ePLND), of whom 441 had cT2-4N0M0 stage disease. • A total of 83 patients received NAC then underwent RC and 358 patients underwent RC only. The ePLND template and the indication for NAC remained the same during the study period.• The incidence of occult LN metastases was compared between the groups. Unadjusted and adjusted odds ratios (ORs) were calculated to investigate the influence of NAC, cT stage, gender and the preoperative staging technique used (computed tomography [CT] or positron emission tomography/CT) on the occurrence of LN metastases.• Overall survival (OS) and disease-specific survival were analysed using the Kaplan-Meier method. Results• Patients in the NAC group more often had locally advanced MIBC than patients in the non-NAC group (cT3-4: 88.0 vs 30.2%). In the NAC group, 19.3% of patients had LN metastases vs 28.5% of the patients in the non-NAC group (P = 0.099). In the patients with cT3-4 disease, the occurrence of LN metastases was significantly lower in the NAC group than in the non-NAC group (21.9 vs 40.7%, respectively, P = 0.002).• In multivariable analysis, adjusting for cT stage, gender and staging method, NAC was independently associated with a lower likelihood of LN metastases (OR: 0.41, 95% CI 0.21-0.79; P = 0.008).• Among the patients with cT3-4 disease, the median OS was significantly longer in the NAC group than in the non-NAC group (68.0 vs 23.0 months, P = 0.047) Conclusion• These data suggest that, along with a downstaging effect on the primary bladder tumour, NAC is associated with a lower incidence of occult LN metastases at the time of RC.

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Section: Discussionmentioning

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Occult lymph node metastases in patients with carcinoma invading bladder muscle: incidence after neoadjuvant chemotherapy and cystectomy vs after cystectomy alone

et al. 2014

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“…In contrast, in a small comparative series by Mertens et al [36], the rate of pCR for patients with non–organ-confined BCa receiving CaG was 30.4%. The authors concluded that CaG might be a reasonable alternative to cisplatin in unfit patients.…”

Section: Discussionmentioning

confidence: 86%

Multicenter Assessment of Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer

et al. 2015

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Background The efficacy of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (BCa) was established primarily with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), with complete response rates (pT0) as high as 38%. However, because of the comparable efficacy with better tolerability of gemcitabine and cisplatin (GC) in patients with metastatic disease, GC has become the most commonly used regimen in the neoadjuvant setting. Objective We aimed to assess real-world pathologic response rates to NAC with different regimens in a large, multicenter cohort. Design, setting, and participants Data were collected retrospectively at 19 centers on patients with clinical cT2–4aN0M0 urothelial carcinoma of the bladder who received at least three cycles of NAC, followed by radical cystectomy (RC), between 2000 and 2013. Intervention NAC and RC Outcome measurements and statistical analysis The primary outcome was pathologic stage at cystectomy. Univariable and multivariable analyses were used to determine factors predictive of pT0N0 and ≤pT1N0 stages. Results and limitations Data were collected on 935 patients who met inclusion criteria. GC was used in the majority of the patients (n = 602; 64.4%), followed by MVAC (n = 183; 19.6%) and other regimens (n = 144; 15.4%). The rates of pT0N0 and ≤pT1N0 pathologic response were 22.7% and 40.8%, respectively. The rate of pT0N0 disease for patients receiving GC was 23.9%, compared with 24.5% for MVAC (p = 0.2). There was no difference between MVAC and GC in pT0N0 on multivariable analysis (odds ratio: 0.89 [95% confidence interval, 0.61–1.34]; p = 0.6). Conclusions Response rates to NAC were lower than those reported in prospective randomized trials, and we did not discern a difference between MVAC and GC. Without any evidence from randomized prospective trials, the best NAC regimen for invasive BCa remains to be determined. Patient summary There was no apparent difference in the response rates to the two most common presurgical chemotherapy regimens for patients with bladder cancer.

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“…Patients were treated with different platinumcontaining chemotherapy regimens: MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin), gemcitabine and cisplatin, or gemcitabine and carboplatin. Although evidence for the benefit of gemcitabine and carboplatin in the neoadjuvant setting in terms of cancer-specific or overall survival is lacking, pathologic complete response rates appear to be similar [8]. Our cohort also contained more advanced cases than most neoadjuvant studies in bladder cancer.…”

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confidence: 98%

ERBB2 Mutations Characterize a Subgroup of Muscle-invasive Bladder Cancers with Excellent Response to Neoadjuvant Chemotherapy

et al. 2016

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Carboplatin Based Induction Chemotherapy for Nonorgan Confined Bladder Cancer—A Reasonable Alternative for Cisplatin Unfit Patients?

Cited by 39 publications

References 21 publications

Occult lymph node metastases in patients with carcinoma invading bladder muscle: incidence after neoadjuvant chemotherapy and cystectomy vs after cystectomy alone

Occult lymph node metastases in patients with carcinoma invading bladder muscle: incidence after neoadjuvant chemotherapy and cystectomy vs after cystectomy alone

Multicenter Assessment of Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer

ERBB2 Mutations Characterize a Subgroup of Muscle-invasive Bladder Cancers with Excellent Response to Neoadjuvant Chemotherapy

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