Pooled analysis of clinical outcomes with neoadjuvant cisplatin and gemcitabine chemotherapy for muscle invasive bladder cancer

Abstract

Purpose: Neoadjuvant chemotherapy for muscle invasive bladder cancer has been shown to confer a survival advantage in phase III studies. Although cisplatin and gemcitabine are often used in this setting, a comprehensive evaluation of this regimen is lacking. In this review we summarize the efficacy of neoadjuvant cisplatin and gemcitabine chemotherapy for muscle invasive bladder cancer based on currently published studies.

Materials and methods: A systematic literature review was conducted in April 2012 searching MEDLINE® databases. Articles were selected if they included patients with muscle invasive bladder cancer, evaluated the combination of cisplatin and gemcitabine as neoadjuvant treatment, and reported pathological data after cystectomy. Cisplatin and gemcitabine dosing regimens and clinical data were further summarized using weighted averages.

Results: Seven studies encompassing 164 patients were published between 2007 and 2012. The majority of patients (79%) received cisplatin and gemcitabine on a 21-day cycle. A weighted average of 19.2 lymph nodes was obtained at cystectomy, and 29.7% of patients were found to have pN1 disease. Pathological down staging to pT0 and less than pT2 occurred in 42 (25.6%) and 67 (46.5%) patients, respectively.

Conclusions: Neoadjuvant cisplatin and gemcitabine yield appreciable pathological response rates in patients with muscle invasive bladder cancer. Since pathological response has been implicated as a potential surrogate for survival in muscle invasive bladder cancer, these data suggest that neoadjuvant cisplatin and gemcitabine may warrant further prospective assessment.

Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Dose and schedule of cisplatin (Cis) and gemcitabine (Gem) administered in 4 of 7 studies in pooled analysis. Cis 70/Gem 2000 (q3wk) indicates 70 mg/m2 cisplatin (single dose or split) with 2,000 mg/m2 gemcitabine (split) on days 1 and 8 of 21-day cycle. Cis 75/Gem 1250 (q3wk) indicates 75 mg/m2 cisplatin with 2,500 mg/m2 gemcitabine (split) on days 1 and 8 of 21-day cycle. Cis 70/Gem 3000 (q4wk) indicates 70 mg/m2 cisplatin (single dose or split) with 3,000 mg/m2 gemcitabine (split) on days 1, 8 and 15 of 28-day cycle.