Mp58-04 dense dose mvac versus gc in patients with ct3-4a bladder cancer treated with radical cystectomy: a real world experience

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2017MP58-04 DENSE DOSE MVAC VERSUS GC IN PATIENTS WITH CT3-4A BLADDER CANCER TREATED WITH RADICAL CYSTECTOMY: A REAL WORLD EXPERIENCE Homayoun Zargar, Jay B Shah, Elisabeth E Fransen van de Putte, Kylea R. Potvin, Kamran Zargar-Shoshtari, Bas W van Rhijn, Siamak Daneshmand, Jeff M Holzbeierlein, Philippe E Spiess, Eric Winquist, Simon Horenblas, Colin Dinney, Adrian S Fairey, Evan Kovac, Laura-Maria Krabbe, Michael S Cookson, Niels-Erik Jacobsen, Nilay Gandhi, Joshua Griffin, Jeffrey S Montgomery, Nikhil Vasdev, Evan Y Yu, Evanguelos Xylinas, Nicholas J. Campain, Jo-An Seah, Cesar E Ercole, Srikala S Sridhar, John S McGrath, Jonathan Aning, Shahrokh F Shariat, Jonathan L Wright, Andrew C Thorpe, Todd M Morgan, Petros Grivas, Andrew J Stephenson, Trinity J Bivalacqua, Scott North, Daniel A Barocas, Yair Lotan, Peter C Black, and Wassim Kassouf Homayoun ZargarHomayoun Zargar More articles by this author , Jay B ShahJay B Shah More articles by this author , Elisabeth E Fransen van de PutteElisabeth E Fransen van de Putte More articles by this author , Kylea R. PotvinKylea R. Potvin More articles by this author , Kamran Zargar-ShoshtariKamran Zargar-Shoshtari More articles by this author , Bas W van RhijnBas W van Rhijn More articles by this author , Siamak DaneshmandSiamak Daneshmand More articles by this author , Jeff M HolzbeierleinJeff M Holzbeierlein More articles by this author , Philippe E SpiessPhilippe E Spiess More articles by this author , Eric WinquistEric Winquist More articles by this author , Simon HorenblasSimon Horenblas More articles by this author , Colin DinneyColin Dinney More articles by this author , Adrian S FaireyAdrian S Fairey More articles by this author , Evan KovacEvan Kovac More articles by this author , Laura-Maria KrabbeLaura-Maria Krabbe More articles by this author , Michael S CooksonMichael S Cookson More articles by this author , Niels-Erik JacobsenNiels-Erik Jacobsen More articles by this author , Nilay GandhiNilay Gandhi More articles by this author , Joshua GriffinJoshua Griffin More articles by this author , Jeffrey S MontgomeryJeffrey S Montgomery More articles by this author , Nikhil VasdevNikhil Vasdev More articles by this author , Evan Y YuEvan Y Yu More articles by this author , Evanguelos XylinasEvanguelos Xylinas More articles by this author , Nicholas J. CampainNicholas J. Campain More articles by this author , Jo-An SeahJo-An Seah More articles by this author , Cesar E ErcoleCesar E Ercole More articles by this author , Srikala S SridharSrikala S Sridhar More articles by this author , John S McGrathJohn S McGrath More articles by this author , Jonathan AningJonathan Aning More articles by this author , Shahrokh F ShariatShahrokh F Shariat More articles by this author , Jonathan L WrightJonathan L Wright More articles by this author , Andrew C ThorpeAndrew C Thorpe More articles by this author , Todd M MorganTodd M Morgan More articles by this author , Petros GrivasPetros Grivas More articles by this author , Andrew J StephensonAndrew J Stephenson More articles by this author , Trinity J BivalacquaTrinity J Bivalacqua More articles by this author , Scott NorthScott North More articles by this author , Daniel A BarocasDaniel A Barocas More articles by this author , Yair LotanYair Lotan More articles by this author , Peter C BlackPeter C Black More articles by this author , and Wassim KassoufWassim Kassouf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1799AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Level I evidence supports the utility of neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (BCa). Although this evidence is derived primarily from phase III trials that used the combination of methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) or cisplatin/methotrexate/vinblastine (CMV), the alternative and less toxic regimen gemcitabine/cisplatin (GC) is currently used more commonly for NAC. Since dose dense (dd)-MVAC has mostly replaced traditional MVAC, we aimed to compare pathological response and survival rates in patients with locally advanced BCa receiving ddMVAC versus GC. METHODS We retrospectively reviewed records of patients with urothelial cancer who received NAC and underwent cystectomy at 19 contributing institutions from 2000-2013. Patients with cT3-4aN0M0 were selected for this analysis. The rate of pT0N0 and pT≤1N0 was compared between GC and ddMVAC regimens. A Multivariable Cox proportional hazards regression model for overall mortality was generated to evaluate hazard ratios (HRs) for variables of interest (age, LVI, hydronephrosis, type of chemotherapy regimen, surgical margin). RESULTS Of 1865 patients undergoing NAC and RC during the study period, 319 met our inclusion criteria (table 1). A significantly lower rate of pT0N0 was observed in the GC arm compared to ddMVAC (14.6% vs. 28.0%; p=0.005). The rate of pT≤1N0 was 30.1% for GC compared to 41.0% for ddMVAC (p=0.07). The Kaplan-Meier mean estimate of overall survival for GC and ddMVAC patients was 4.2 and 7.0 years, respectively (p=0.001). In multivariable cox regression analysis, GC patients were at higher risk of death compared to ddMVAC patients (HR 1.9, 95%CI (1.2-3.1); p=0.006). Presence of LVI (HR 2.1, 95%CI (1.2-3.6); p=0.007), hydronephrosis (HR 1.9, 95%CI (1.3-2.9); p=0.002) and positive surgical margin (HR 1.4, 95%CI (1.2-1.7); p<0.001) were also associated with higher risk of death. CONCLUSIONS In our retrospective cohort of locally advanced BCa patients, ddMVAC was associated with a higher rate of pathologic down-staging response and improved longer survival when compared to GC. A clinical trial is warranted to validate these hypothesis-generating results superiority of neoadjuvant ddMVAC in patients with locally advanced BCa. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e773-e774 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Homayoun Zargar More articles by this author Jay B Shah More articles by this author Elisabeth E Fransen van de Putte More articles by this author Kylea R. Potvin More articles by this author Kamran Zargar-Shoshtari More articles by this author Bas W van Rhijn More articles by this author Siamak Daneshmand More articles by this author Jeff M Holzbeierlein More articles by this author Philippe E Spiess More articles by this author Eric Winquist More articles by this author Simon Horenblas More articles by this author Colin Dinney More articles by this author Adrian S Fairey More articles by this author Evan Kovac More articles by this author Laura-Maria Krabbe More articles by this author Michael S Cookson More articles by this author Niels-Erik Jacobsen More articles by this author Nilay Gandhi More articles by this author Joshua Griffin More articles by this author Jeffrey S Montgomery More articles by this author Nikhil Vasdev More articles by this author Evan Y Yu More articles by this author Evanguelos Xylinas More articles by this author Nicholas J. Campain More articles by this author Jo-An Seah More articles by this author Cesar E Ercole More articles by this author Srikala S Sridhar More articles by this author John S McGrath More articles by this author Jonathan Aning More articles by this author Shahrokh F Shariat More articles by this author Jonathan L Wright More articles by this author Andrew C Thorpe More articles by this author Todd M Morgan More articles by this author Petros Grivas More articles by this author Andrew J Stephenson More articles by this author Trinity J Bivalacqua More articles by this author Scott North More articles by this author Daniel A Barocas More articles by this author Yair Lotan More articles by this author Peter C Black More articles by this author Wassim Kassouf More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...