Peyton CC, et al. - Given that for patients with bladder cancer, neoadjuvant chemotherapy (NAC) followed by radical cystectomy improves survival vs cystectomy alone, researchers assessed which NAC regimen is linked with the best outcomes for patients with muscle-invasive bladder cancer. They noted gemcitabine with cisplatin is the most frequently prescribed neoadjuvant chemotherapy regimen for these patients, however, for eligible patients, better outcomes may be possible with dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin.

Methods

• Data extracted from the medical records of a consecutive sample was used for this cross-sectional analysis, after exclusions.
• The sample was comprised of 1,113 patients with bladder cancer; of these 824 had disease stage T2 or greater and were treated with cystectomy at the Moffitt Cancer Center in Tampa, Florida, a tertiary care cancer center, between January 1, 2007 and May 31, 2017.
• Between November 14, 2016 and July 21, 2017, data collection was done; data analysis was performed between August 21, 2017 and December 8, 2017.
• Based on type of NAC, they compared the patients; controls included patients who did not receive NAC.
• They assessed comparative rates and the correlations of any downstaging, complete response, and overall survival with ddMVAC and other NAC regimens and surgery alone, as main outcomes.
• Kaplan-Meier, adjusted logistic, Cox regression, and propensity-weighted models were used to examine outcomes.

Results

• Cystectomy for bladder cancer was performed on 1,113 patients; of these, 861 (77.4%) were male, the median (interquartile range) age was 67 (60-74) years, 1051 (94.4%) were white, 27 (2.4%) black, 37 (3.3%) Hispanic/Latino, and 35 (3.1%) other race/ethnicity.
• Among 824 patients with muscle-invasive bladder cancer, NAC was received by 332 (40%) patients.
• For ddMVAC, gemcitabine-cisplatin, and gemcitabine with carboplatin, downstaging rates were 52.2%, 41.3%, and 27.0%, respectively, and complete response (pT0N0) rates were 41.3%, 24.5%, and 9.4%, respectively, (2-sided P < .001).
• In adjusted analysis comparing ddMVAC with gemcitabine-cisplatin, ddMVAC was demonstrated to have a higher likelihood of downstaging (odds ratio [OR], 1.84; 95% CI, 1.10-3.09) and complete response (OR, 2.67; 95% CI, 1.50-4.77).
• Propensity score matching showed similar results (OR, 1.52; 95% CI, 0.99-2.35).
• Better overall survival was evident for patients who received ddMVAC than those treated with other chemotherapy regimens, however, in adjusted or propensity-matched models, the observed survival benefit did not reach statistical significance (hazard ratio, 0.44; 95% CI, 0.14-1.38; P=.16).