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Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience

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Abstract

Purpose

Neoadjuvant chemotherapy in muscle-invasive bladder cancer (MIBC) patients has proven beneficial in overall survival. However, the optimal regimen is still a matter of debate.

Materials and methods

In this retrospective analysis, we evaluate the results obtained in 42 patients treated in our center with 4 cycles of neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) followed by radical cystectomy from August 2015 to October 2020. All patients had cT2 or higher non-metastatic MIBC. Clinical and pathological outcomes are reported.

Results

Of the 42 patients, 90.5% were men (n = 38) and the mean age was 65 years. All of them had ECOG 0–1 at diagnosis and most tumors had an initial clinical stage T2N0 (76%). Thirty-six patients (85.7%) completed 4 cycles of neoadjuvant treatment, and 21.4% required a dose reduction. The most frequent adverse event (AE) was grade 1–2 asthenia (81%), while neutropenia was the most frequent grade 3 or higher AE (38%). Complete pathological response (ypT0, ypN0) was achieved in 50% of patients (n = 21), and down-staging was observed in 57.1% (n = 24). Only one patient presented radiological progressive disease during neoadjuvant treatment (2.4%), and after a mean follow-up time of 31.5 months, 33.3% of patients experienced disease recurrence.

Conclusions

Neoadjuvant chemotherapy with 4 cycles of dd-MVAC is an effective regimen with high rates of pathological complete responses and down-staging along with an acceptable toxicity profile. DD-MVAC should be considered as an alternative to cisplatin and gemcitabine in patients with good clinical performance status.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, ID.

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Authors and Affiliations

  1. Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

    Marina Serrano, Nerea Muñoz-Unceta, Lucía Andrea Alonso, Diego Cacho, Marta López-Brea, Marta Sotelo & Ignacio Duran

  2. Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain

    Ainara Azueta

  3. Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain

    José Luis Gutiérrez Baños, Mario Domínguez, Roberto Ballestero, Félix Campos-Juanatey & Enrique Ramos Barseló

  4. Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain

    Laura Ferreira

  5. Medical Oncology Department, Hospital Universitario Virgen Macarena, Seville, Spain

    Albero Torres Zurita

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  1. Marina Serrano
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  2. Nerea Muñoz-Unceta
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Correspondence to Ignacio Duran.

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Serrano, M., Muñoz-Unceta, N., Alonso, L.A. et al. Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience. Clin Transl Oncol 26, 549–553 (2024). https://doi.org/10.1007/s12094-023-03277-4

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