Carboplatin Induction Chemotherapy in Clinically Lymph Node-positive Bladder Cancer
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AbstractBackground: There are currently no guideline recommendations regarding the treatment of cisplatin-ineligible, clinically lymph node-positive (cN+) bladder can-cer (BCa).Objective: To investigate the oncological efficacy of gemcitabine/carboplatin induc-tion chemotherapy (IC) in comparison to cisplatin-based regimens in cN+ BCa. Design, setting, and participants: This was an observational study of 369 patients with cT2-4 N1-3 M0 BCa.Intervention: IC followed by consolidative radical cystectomy (RC). Outcome measurements and statistical analysis: The primary endpoints were the pathological objective response (pOR; ypT0/Ta/Tis/T1 N0) rate and the pathological complete response (pCR; ypT0N0) rate. We applied 3:1 propensity score matching (PSM) to reduce selection bias. Overall survival (OS) and cancer-specific survival (CSS) were compared across groups using the Kaplan-Meier method. Associations between the treatment regimen and survival endpoints were tested in multivari-able Cox regression analyses. Results and limitations: After PSM, a cohort of 216 patients was available for analysis, of whom 162 received cisplatin-based IC and 54 gemcitabine/carboplatin IC. At RC, 54 patients (25%) had a pOR and 36 (17%) had a pCR. The 2-yr CSS was 59.8% (95% con-fidence interval [CI] 51.9-69%) for patients who received cisplatin-based IC versus 38.8% (95% CI 26-57.9%) for those who received gemcitabine/carboplatin. For the pOR (p = 0.8), ypN0 status at RC (p = 0.5), and cN1 BCa subgroups (p = 0.7), there was no difference in CSS between cisplatin-based IC and gemcitabine/carboplatin. In the cN1 subgroup, treatment with gemcitabine/carboplatin was not associated with shorter OS (p = 0.2) or CSS (p = 0.1) on multivariable Cox regression analysis.Conclusions: Cisplatin-based IC seems to be superior to gemcitabine/carboplatin and should be the standard for cisplatin-eligible patients with cN+ BCa. Gemcitabine/carboplatin may be an alternative treatment for selected cisplatin-ineligible patients with cN+ BCa. In particular, selected cisplatin-ineligible patients with cN1 disease may benefit from gemcitabine/carboplatin IC.Patient summary: In this multicenter study, we found that selected patients with bladder cancer and clinical evidence of lymph node metastasis who cannot receive standard cisplatin-based chemotherapy before surgery to remove their bladder may benefit from chemotherapy with gemcitabine/carboplatin. Patients with a sin-gle lymph node metastasis may benefit the most.
Acceptance Date23/02/2023
All Author(s) Listvon Deimling M, Mertens LS, van Rhijn BWG, Lotan Y, Spiess PE, Daneshmand S, Black PC, Pallauf M, D'Andrea D, Moschini M, Soria F, Del Giudice F, Afferi L, Laukhtina E, Yanagisawa T, Kawada T, Teoh JY, Abufaraj M, Ploussard G, Roumiguié M, Karakiewicz PI, Babjuk M, Gontero P, Xylinas E, Rink M, Shariat SF, Pradere B
Journal nameEuropean Urology Open Science
Volume Number51
Pages39 - 46
LanguagesEnglish-United Kingdom
KeywordsCarboplatin, Induction chemotherapy, Oligometastatic, Survival, Urinary bladder neoplasms

Last updated on 2024-16-04 at 00:34