Introduction

Level I evidence supports the utility of neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (BCa). Although this evidence is derived primarily from phase III trials that used the combination of methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) or cisplatin/methotrexate/vinblastine (CMV), the alternative and less toxic regimen gemcitabine/cisplatin (GC) is currently used more commonly for NAC. Since dose dense (dd)-MVAC has mostly replaced traditional MVACOur primary endpoint was to assess the rate of pT0N0 and ≤pT1N0 for patients with BCa treated with the accelerated or dose dense MVAC (ddMVAC) chemotherapy followed by radical cystectomy (RC) in this real-word multi-institutional cohort. _x000D_

Methods

We retrospectively reviewed records of patients with urothelial cancer who underwent ddMVAC and RC at seven contributing institutions from 2000-2015. Patients with cT2–4a,M0 BCa were included. Presence of cT3-4 disease, hydronephrosis, lymphovascular invasion and/or existence of sarcomatoid, or micropapillary features on the initial transurethral resection of bladder tumor specimen was defined as high-risk disease. Logistic regression models for prediction of pT0N0 and ≤pT1N0 were generated for the entire cohort as well as for the cN0 subgroup. The multivariable Cox proportional hazards regression model for survival using post RC data was used to assess hazard ratios (HRs) for the variables of interest._x000D_

Results

A total of 345 patients received ddMVAC chemotherapy during the study period. The observed rates of pT0N0 and ≤pT1N0 were 30.4% and 49.3%, respectively among cN0 patients. On the multivariable regression model, the presence of more than one clinical high-risk element was associated with 70% (OR 0.30 95%CI (0.10-0.86); p=0.02) reduction in the probability of achieving partial pathological response.

Conclusions

A complete response (pT0N0) was observed in one third of patients after neoadjuvant ddMVAC therapy, and a partial response (≤pT1N0) was observed in nearly half of the cases in this real-world experience with this regimen. To our knowledge, this represents the largest experience outside clinical trial settings. _x000D_

Funding

None