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Adv Urol. 2013;2013:317190. doi: 10.1155/2013/317190. Epub 2013 Dec 8.

Pathologic Response Rates of Gemcitabine/Cisplatin versus Methotrexate/Vinblastine/Adriamycin/Cisplatin Neoadjuvant Chemotherapy for Muscle Invasive Urothelial Bladder Cancer.

Author information

1
Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA ; Department of Urology, University of Washington Medical Center, Health Sciences Building, 1959 NE Pacific, BB-1115, Box 356510, Seattle, WA 98195, USA.
2
Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA ; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
3
Group Health Permanente, Seattle, WA 98109, USA.
4
Huntsman Cancer Institute, Division of Medical Oncology, The University of Utah, Salt Lake City, UT 84112, USA.
5
Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
6
Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA ; Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.

Abstract

OBJECTIVES:

To compare pathologic outcomes after treatment with gemcitabine and cisplatin (GC) versus methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) in the neoadjuvant setting.

METHODS:

Data was retrospectively collected on 178 patients with T2-T4 bladder cancer who underwent radical cystectomy between 2003 and 2011. Outcomes of interest included those with complete response (pT0) and any response (≤pT1). Odds ratios were calculated using multivariate logistic regression.

RESULTS:

Compared to those who did not receive neoadjuvant chemotherapy, there were more patients with complete response (28% versus 9%, OR 3.11 (95% CI: 1.45-6.64), P = 0.03) and any response (52% versus 25%, OR 3.23 (95% CI: 1.21-8.64), P = 0.01). Seventy-two patients received GC (n = 41) or MVAC (n = 31). CR was achieved in 29% and 22% of GC and MVAC patients, respectively (multivariate OR 0.39, 95% CI 0.10-1.58). Any response (≤pT1) was achieved in 56% of GC and 45% of MVAC patients (multivariate OR 0.45, 95% CI 0.12-1.71).

CONCLUSIONS:

We observed similar pathologic response rates for GC and MVAC neoadjuvant chemotherapy in this cohort of patients with muscle invasive urothelial cancer (MIBC). Our findings support the use of GC as an alternative regimen in the neoadjuvant setting.

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