A Role for Neoadjuvant Gemcitabine Plus Cisplatin in Muscle-Invasive Urothelial Carcinoma of the Bladder A Retrospective Experience

作者：Dash Atreya; Pettus Joseph A; Herr Harry W; Bochner Bernard H; Dalbagni Guido; Donat S Machele; Russo Paul; Boyle Mary G; Milowsky Matthew I; Bajorin Dean F^*

来源：Cancer, 2008, 113(9): 2471-2477.

DOI：10.1002/cncr.23848

• urothelial carcinoma
• neoadjuvant
• chemotherapy
• cisplatin
• radical cystectomy

BACKGROUND. Neoadjuvant cisplatin-based chemotherapy improves survival in muscle-invasive urothelial cancer, with MVAC methotrexate, vinblastine, doxorubicin and cisplatin) considered the standard regimen. Gemcitabine plus cisplatin (GC) has similar efficacy and less toxicity than MVAC in metastatic disease, but is untested as neoadjuvant treatment.
METHODS. The authors retrospectively evaluated patients with muscle-invasive Urothelial carcinoma who received neoadjuvant GC before radical cystectomy between November 2000 and December 2006 at Memorial Sloan-Kettering Cancer Center. Post-therapy pathological downstaging to either residual disease at cystectomy (pT0) or no residual muscle-invasion (RESULTS. Four cycles of neoadjuvant GC were given over 12 weeks (n = 42). Thirty-nine (93%) of 42 patients received 4 cycles, with a median 91% drug delivery for cisplatin and 90% for gemcitabine. The PTO proportion was 26% (95% confidence interval [CI], 14-42), and no residual muscle-invasive disease proportion (CONCLUSIONS. Neoadjuvant GC is feasible and allows for timely drug delivery. The proportion of GC-treated patients whose primary tumors were downstaged, with prolonged disease-free survival and minimal or no residual disease, was similar to MVAC-treated patients. Cancer 2008;113:2471-7.

• 出版日期2008-11-1