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Oncologist. 2019 May;24(5):688-690. doi: 10.1634/theoncologist.2018-0561. Epub 2019 Feb 6.

Efficacy of Split Schedule Versus Conventional Schedule Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive Bladder Cancer.

Author information

University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.
University of Rochester Medical Center, Rochester, New York, USA.
Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA.
Langone Medical Center, New York University, New York City, New York, USA.
Florida Cancer Specialists and Research Institute, Sarasota, Florida, USA.
Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA


Neoadjuvant cisplatin-based chemotherapy (NAC; 70 mg/m2) is standard of care for muscle-invasive bladder carcinoma (MIBC). Many patients (pts) cannot receive cisplatin because of renal impairment, and administration of cisplatin 35 mg/m2 on day 1 + 8 or 1 + 2 (i.e., split schedule) is a commonly used alternative. In this retrospective analysis, we compared complete (pT0) and partial (<pT2) pathologic response rates between split schedule (SS) and conventional schedule (CS) pts, after 1:1 matching on chemotherapy regimen, number of cycles, tumor histology, and clinical stage. Eighty matched pts were identified. pT0 rates were 17.5% (95% confidence interval [CI], 7%-33%) and 32.5% (95% CI, 19%-49%) in SS and CS cisplatin pts, respectively (p = .21), corresponding to an odds ratio for pT0 of 0.45 (95% CI, 0.16-1.31) with SS cisplatin. Split schedule cisplatin was associated with numerically but not statistically significant lower pathologic response rates relative to full dose.


Cisplatin; Muscle‐invasive bladder cancer; Neoadjuvant chemotherapy; Nephrotoxicity

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

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