Zargar H, et al. - Herein, researchers undertook a comparative inspection of the pathological response and survival rates in patients with locally advanced bladder cancer (BCa) receiving neoadjuvant cisplatin-based chemotherapy (NAC) with the dose dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) vs gemcitabine and cisplatin (GC). A tie-up was revealed between ddMVAC with a higher rate of complete pathologic response and improved survival when compared to GC.

Methods

• Herein, researchers retrospectively reviewed records of patients with urothelial cancer who received NAC and underwent cystectomy at 20 contributing institutions from 2000-2015.
• They recruited patients with cT3-4aN0M0.
• A comparison was conducted of the rates of ypT0N0 and ≤ ypT1N0 between GC and ddMVAC regimens.
• With the aid of preoperative and postoperative data, 2 multivariable Cox proportional hazards regression models for overall mortality were generated.

Results

• A total of 319 patients met the inclusion criteria, among patients undergoing NAC and RC during the study period.
• Data displayed a substantially lower rate of ypT0N0 in the GC arm compared to ddMVAC (14.6% vs. 28.0%; p=0.005).
• It was reported that the rate of ≤ ypT1N0 was 30.1% for GC compared to 41.0% for ddMVAC (p=0.07).
• The Kaplan-Meier mean estimates of overall survival for GC and ddMVAC patients were determined to be 4.2 and 7.0 years, respectively (p=0.001).
• Higher risk of death was illustrated among GC patients compared to ddMVAC patients [HR 2.07 (95% CI 1.25-3.42; p=0.003)] in the multivariable cox regression analysis based on preoperative data.
• In addition, a correlation was demonstrated between the presence of LVI [HR 1.97 (95% CI 1.15-3.36; p=0.01)] and hydronephrosis [HR 2.18 [95% CI 1.43-3.30; p < 0.001)] with a higher risk of death.