Introduction & Objectives
Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) and pelvic lymph node dissection is standard treatment for non-metastatic muscle-invasive bladder cancer (MIBC).
Gemcitabine-cisplatin (GC) has similar efficacy to the MVAC regimen with lower toxicity in advanced BC and both regimens are considered adequate options for NAC.
We report the experience of our centre with NAC for MIBC.
Material & Methods
We conducted an observational, retrospective, single-centre cohort study. All patients (pts) with non-metastatic MIBC (≥cT2) after initial transurethral resection of the bladder tumour (TURBT), treated with GC between 2012 and 2020 were included.
The primary objective was to evaluate pathological complete response (pCR) rates after NAC, defined as ypT0N0 or ypTisN0. We also assessed disease free survival (DFS) and overall survival (OS) as secondary objectives.
Results
Thirty-nine pts with MIBC were treated with NAC followed by RC between 2012 and 2020. The median age was 66yo (range, 46-79), 31 (80%) were males. At the pre-NAC staging, 36 tumours were T2 (92%), 2 T3 (5%) and 1 T4 (3%). Thirty-four pts received the full 4 cycles of NAC; 11 pts (28%) had to delay at least 1 cycle of NAC due to toxicity and 4 pts (10%) required dose reductions. Eleven pts (28%) had grade 3 or 4 toxicities, mainly hematological (73%). The pCR rate was 28% (11 pts).
With a median follow-up of 57 months, 17 pts (44%) had tumour recurrence, 1 pt after pCR, and 14 pts (36%) died, none of those with pCR.
The association between pCR and DFS (median 22 months if residual disease versus not reached if pCR, log rank p=0.017) and between pCR and OS (median not reached for both groups, log rank p=0.01) were confirmed.
Conclusions
In our single institution cohort, the observed pCR rate (28%) was lower than that reported in the phase III GETUG/AFU V05 VESPER trial comparing dose-dense MVAC with GC (42% vs 36%). However, we alsodocumented a positive association between pCR and both DFS and OS.
While less toxic than MVAC, the full 12-week NAC with GC was only tolerated without treatment delays or dose reductions in 23 of the 39 pts.

Platin-based neoadjuvant chemotherapy for muscle invasive bladder cancer

For 2021, our focus remains: turning new data into your daily practice. The programme will consist of state-of-the-art lectures, case discussions and panel debates. Our faculty is a group of international & multidisciplinary experts.

We will take you on our journey to Ghent and beyond. Prior the congress, we send out case challenges, where you can compare your opinion with peers & experts. These cases will be part of the Global Congresses on Prostate & Bladder Cancer programme during the congress days (12 & 13 October for PROSCA and 14 & 15 October for BLADDR). After these days, you will be updated on prostate & bladder cancer management.