Damien Pouessel1, Sylvie Chevret2, Frédéric Rolland3, Gwenaelle Gravis4, Lionel Geoffrois5, Guilhem Roubaud6, Safae Terrisse7, Helen Boyle8, Christine Chevreau9, Jérôme Dauba10, Guillaume Moriceau11, Ingrid Alexandre12, Gaël Deplanque13, Angélique Chapelle14, Elodie Vauleon15, Alexandre Colau16, François Audenet17, Thomas Grellety18, Stéphane Culine19. 1. Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France. 2. Department of Biostatistics and Medical Information, Hôpital Saint-Louis, AP-HP, Paris, France; Inserm, UMR 717, Hôpital Saint-Louis, AP-HP, Paris, France; Paris Diderot University, Paris, France. 3. Institut de Cancérologie de l'Ouest, Nantes, France. 4. Institut Paoli Calmettes, Marseille, France. 5. Centre Alexis Vautrin, Nancy, France. 6. Institut Bergonié, Bordeaux, France. 7. Institut Gustave Roussy, Villejuif, France. 8. Centre Léon Bérard, Lyon, France. 9. Institut Claudius Régaud, Toulouse, France. 10. Centre Hospitalier, Mont-de-Marsan, France. 11. Institut de Cancérologie de la Loire, Saint-Etienne, France. 12. Centre Médical de Bligny, Briis-sous-Forges, France. 13. Hôpital Saint-Joseph, Paris, France. 14. Centre OncoGard, Nîmes, France. 15. Centre Eugène Marquis, Rennes, France. 16. Hôpital des Diaconesses, France. 17. Hôpital Georges Pompidou, Paris, France. 18. Centre Hospitalier Saint-André, Bordeaux, France. 19. Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France; Paris Diderot University, Paris, France. Electronic address: stephane.culine@aphp.fr.
Abstract
BACKGROUND: There is continuing controversy regarding the optimal regimen for neoadjuvant chemotherapy (NAC) in bladder cancer. PATIENTS AND METHODS: We performed a retrospective analysis of 241 consecutive bladder cancer patients who received a combination of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) using a standard (52 patients) or an accelerated schedule (189 patients) as NAC before radical cystectomy in 17 centres of the French GEnito-urinary TUmour Group from March 2004-May 2013. RESULTS: The median age was 62 years. As expected, the median number of cycles, the median total dose of cisplatin and the median cisplatin dose intensity were higher in patients treated with the accelerated regimen. Conversely, the median duration of chemotherapy was shorter. Regarding toxicity, grade III/IV neutropenia, grade III thrombocytopenia and grade III anaemia as well were more frequently observed in patients treated with the standard regimen. Among 211 (88%) patients who proceeded to cystectomy, 75 (35%) patients achieved an ypT0 pN0 status (no pathologic residual tumour cells) with no significant difference according to the MVAC schedule. Three-year overall survival rates were 66.5% (95% confidence interval [CI], 56-79) and 72% (95% CI, 59.5-88) in the standard and accelerated cohorts, respectively. In the multivariate analysis, two independent prognostic parameters were retained: the ypT0 stage and the ypN0 stage. Heterogeneity test did not show any interaction with NAC regimens. CONCLUSION: Similar pathological response and survival rates were observed whatever the chemotherapy regimen used. Haematological toxicity was greater in patients who received standard MVAC.
BACKGROUND: There is continuing controversy regarding the optimal regimen for neoadjuvant chemotherapy (NAC) in bladder cancer. PATIENTS AND METHODS: We performed a retrospective analysis of 241 consecutive bladder cancerpatients who received a combination of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) using a standard (52 patients) or an accelerated schedule (189 patients) as NAC before radical cystectomy in 17 centres of the French GEnito-urinary TUmour Group from March 2004-May 2013. RESULTS: The median age was 62 years. As expected, the median number of cycles, the median total dose of cisplatin and the median cisplatin dose intensity were higher in patients treated with the accelerated regimen. Conversely, the median duration of chemotherapy was shorter. Regarding toxicity, grade III/IV neutropenia, grade III thrombocytopenia and grade III anaemia as well were more frequently observed in patients treated with the standard regimen. Among 211 (88%) patients who proceeded to cystectomy, 75 (35%) patients achieved an ypT0 pN0 status (no pathologic residual tumour cells) with no significant difference according to the MVAC schedule. Three-year overall survival rates were 66.5% (95% confidence interval [CI], 56-79) and 72% (95% CI, 59.5-88) in the standard and accelerated cohorts, respectively. In the multivariate analysis, two independent prognostic parameters were retained: the ypT0 stage and the ypN0 stage. Heterogeneity test did not show any interaction with NAC regimens. CONCLUSION: Similar pathological response and survival rates were observed whatever the chemotherapy regimen used. Haematological toxicity was greater in patients who received standard MVAC.
Authors: Izak Faiena; Amirali Salmasi; Neil Mendhiratta; Andrew T Lenis; Aydin Pooli; Alexandra Drakaki; Kiran Gollapudi; Jeremy Blumberg; Allan J Pantuck; Karim Chamie Journal: World J Urol Date: 2018-05-11 Impact factor: 4.226
Authors: Jeffrey J Leow; Jens Bedke; Karim Chamie; Justin W Collins; Siamak Daneshmand; Petros Grivas; Axel Heidenreich; Edward M Messing; Trevor J Royce; Alexander I Sankin; Mark P Schoenberg; William U Shipley; Arnauld Villers; Jason A Efstathiou; Joaquim Bellmunt; Arnulf Stenzl Journal: World J Urol Date: 2019-01-25 Impact factor: 4.226