The optimal number of induction chemotherapy cycles in clinically lymph node-positive bladder cancer
Por:
von Deimling, M, Mertens, LS, Furrer, M, Li, RG, Tendijck, GAH, Taylor, J, Crocetto, F, Maas, M, Mari, A, Pichler, R, Moschini, M, Tully, KH, D'Andrea, D, Laukhtina, E, Del Giudice, F, Marcq, G, Velev, M, Gallioli, A, Albisinni, S, Mori, K, Khanna, A, Rink, M, Fisch, M, Minervini, A, Black, PC, Lotan, Y, Spiess, PE, Kiss, B, Shariat, SF, Pradere, B
Publicada:
12 mar 2024
Ahead of Print:
1 mar 2024
Resumen:
Objective To investigate the optimal number of induction chemotherapy cycles needed to achieve a pathological response in patients with clinically lymph node-positive (cN+) bladder cancer (BCa) who received three or four cycles of induction chemotherapy followed by consolidative radical cystectomy (RC) with pelvic lymph node dissection. Patients and Methods We included 388 patients who received three or four cycles of cisplatin/gemcitabine or (dose-dense) methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), followed by consolidative RC for cTanyN1-3M0 BCa. We compared pathological complete (pCR = ypT0N0) and objective response (pOR = yp <= T1N0) between treatment groups. Predictors of pCR and/or pOR were assessed using uni- and multivariable logistic regression analysis. The secondary endpoints were overall (OS) and cancer-specific survival (CSS). We evaluated the association between the number of induction chemotherapy cycles administered and survival outcomes on multivariable Cox regression. Results Overall, 101 and 287 patients received three or four cycles of induction chemotherapy, respectively. Of these, 72 (19%) and 128 (33%) achieved pCR and pOR response, respectively. The pCR (20%, 18%) and pOR (40%, 31%) rates did not differ significantly between patients receiving three or four cycles (P > 0.05). The number of cycles was not associated with pCR or pOR on multivariable logistic regression analyses. The 2-year OS estimates were 63% (95% confidence interval [CI] 0.53-0.74) and 63% (95% CI 0.58-0.7) for patients receiving three or four cycles, respectively. Receiving three vs four cycles was not associated with OS and CSS on uni- or multivariable Cox regression analyses. Conclusion Pathological response and survival outcomes did not differ between administering three or four induction chemotherapy cycles in patients with cN+ BCa. A fewer cycles (minimum three) may be oncologically sufficient in patients with cN+ BCa, while decreasing the wait for definitive local therapy in those patients who end up without a response to chemotherapy. This warrants further validation.
Filiaciones:
von Deimling, M:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
Mertens, LS:
Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands
Furrer, M:
Univ Bern, Univ Hosp Bern, Dept Urol, Bern, Switzerland
Kantonsspital Olten, Solothurner Spitaler AG, Dept Urol, Olten, Switzerland
Burgerspital, Biberist, Switzerland
Li, RG:
H Lee Moffitt Canc Ctr & Res Inst, Dept Genitourinary Oncol, Tampa, FL USA
Tendijck, GAH:
Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands
Taylor, J:
Univ Texas Southwestern, Dept Urol, Dallas, TX USA
Crocetto, F:
Univ Naples Federico II, Dept Neurosci Reprod Sci & Odontostomatol, Naples, Italy
Maas, M:
Eberhard Karls Univ Tubingen, Dept Urol, Tubingen, Germany
Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada
Mari, A:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, Florence, Italy
Pichler, R:
Med Univ Innsbruck, Comprehens Canc Ctr Innsbruck, Dept Urol, Innsbruck, Austria
Moschini, M:
Vita Salute San Raffaele, Urol Res Inst, Dept Urol, Milan, Italy
Tully, KH:
Ruhr Univ Bochum, Marien Hosp Herne, Dept Urol & Neurourol, Herne, Germany
D'Andrea, D:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Laukhtina, E:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Del Giudice, F:
Sapienza Rome Univ, Policlin Umberto Hosp 1, Dept Maternal Infant & Urol Sci, Rome, Italy
Marcq, G:
CHU Lille, Claude Huriez Hosp, Dept Urol, Lille, France
Univ Lille, Inst Pasteur Lille, CANTHER Canc Heterogene Plast & Resistance Therapi, CNRS,Inserm,CHU Lille,UMR9020 U1277, F-59000 Lille, France
Velev, M:
Univ Paris Saclay, Dept Canc Med, Gustave Roussy, Villejuif, France
Gallioli, A:
Autonomous Univ Barcelona, Dept Urol, Fdn Puigvert, Barcelona, Spain
Albisinni, S:
Univ Roma Tor Vergata, Tor Vergata Univ Hosp, Dept Surg Sci, Urol Unit, Rome, Italy
Univ Libre Bruxelles, Hop Erasme, Serv Urol, Brussels, Belgium
Mori, K:
Jikei Univ, Sch Med, Dept Urol, Tokyo, Japan
Khanna, A:
Mayo Clin, Dept Urol, Rochester, MN USA
Rink, M:
Katholisches Marienkrankenhaus, Dept Urol, Hamburg, Germany
Fisch, M:
Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
Minervini, A:
Univ Florence, Careggi Hosp, Dept Expt & Clin Med, Unit Oncol Minimally Invas Urol & Androl, Florence, Italy
Black, PC:
Univ British Columbia, Dept Urol Sci, Vancouver, BC, Canada
Lotan, Y:
Univ Texas Southwestern, Dept Urol, Dallas, TX USA
Spiess, PE:
H Lee Moffitt Canc Ctr & Res Inst, Dept Genitourinary Oncol, Tampa, FL USA
Kiss, B:
Univ Bern, Univ Hosp Bern, Dept Urol, Bern, Switzerland
Shariat, SF:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
Karl Landsteiner Inst Urol & Androl, Vienna, Austria
Univ Texas Southwestern, Dept Urol, Dallas, TX USA
Weill Cornell Med Coll, Dept Urol, New York, NY USA
Al Ahliyya Amman Univ, Hourani Ctr Appl Sci Res, Amman, Jordan
Charles Univ Prague, Fac Med 2, Dept Urol, Prague, Czech Republic
Med Univ Vienna, Vienna Gen Hosp, Comprehens Canc Ctr, Dept Urol, Wahringer Gurtel 18-20, A-1090 Vienna, Austria
Pradere, B:
Med Univ Vienna, Comprehens Canc Ctr, Dept Urol, Vienna, Austria
La Croix Du Sud Hosp, Dept Urol, Urosud, Quint Fonsegrives, France
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