Abstract
Purpose
To compare the efficacy and safety of high dose-intensity combination of methotrexate, vinblastine, adriamycin and cisplatin (HD MVAC) with gemcitabine plus cisplatin (GC) as a neoadjuvant chemotherapy (NAC) in muscle-invasive bladder cancer (MIBC) or locally advanced upper tract urothelial cancer (UTUC).
Patients and methods
A retrospective analysis was conducted for patients with UC (cT2-4aN0-1M0) who received NAC from January 2011 and December 2017 at Asan Medical Center. Pathologic complete response (pCR), down-staging (< ypT2 and no N upstaging), disease-free survival (DFS), OS and safety were compared for each regimen.
Results
Out of a total of 277 patients, 176 patients received GC and 41 patients received HD MVAC. With the exception of age (patients receiving HD MVAC were younger; p = 0.002), other baseline characteristics were well balanced between groups. pCR rates were 27.0% for GC and 22.6% for HD MVAC (p = 0.62), and down-staging rate was 50.8% for GC and 58.1% for HD MVAC (p = 0.47). There were no differences in OS (72.1% vs 73.1% for GC vs HD MVAC; p = 0.58) and DFS (54.9% vs 63.3% for GC vs HD MVAC; p = 0.21) at 3 years. HD MVAC with prophylactic G-CSF was associated with a higher incidence of febrile neutropenia (p < 0.001) than GC. The NAC regimen was not an independent prognostic factor for OS.
Conclusion
Oncologic outcomes were not significantly different between the GC and HD MVAC when used as NAC in MIBC/UTUC.
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Dr. YJ Lee and JL Lee had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: YJ Lee, JL Lee. Acquisition, analysis, or interpretation of data: YJ Lee, JL Lee, YS Kim, BS Hong, YM Cho, JL Lee. Drafting of the manuscript: YJ Lee, JL Lee. Critical revision of the manuscript for important intellectual content: YJ Lee, JL Lee, YS Kim, BS Hong, YM Cho, JL Lee. Statistical analysis: YJ Lee, JL Lee. Administrative, technical, or material support: YJ Lee, JL Lee, YS Kim, BS Hong, YM Cho, JL Lee. Data analysis: YJ Lee, JL Lee.
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Lee, Y., Kim, Y.S., Hong, B. et al. Comparison of clinical outcomes in patients with localized or locally advanced urothelial carcinoma treated with neoadjuvant chemotherapy involving gemcitabine–cisplatin and high dose-intensity MVAC. J Cancer Res Clin Oncol 147, 3421–3429 (2021). https://doi.org/10.1007/s00432-021-03582-x
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DOI: https://doi.org/10.1007/s00432-021-03582-x