Pd34-12 the Optimal Number of Induction Chemotherapy Cycles in Clinically Lymph Node-Positive Bladder Cancer

You have accessJournal of UrologyBladder Cancer: Invasive III (PD34)1 May 2024PD34-12 THE OPTIMAL NUMBER OF INDUCTION CHEMOTHERAPY CYCLES IN CLINICALLY LYMPH NODE-POSITIVE BLADDER CANCER Markus von Deimling, Laura S. Mertens, Marc Furrer, Roger Li, Guus A. H. Tendijck, Jacob Taylor, Felice Crocetto, Moritz Maas, Andrea Mari, Renate Pichler, Marco Moschini, Karl H. Tully, David D'Andrea, Ekaterina Laukhtina, Francesco Del Giudice, Gautier Marcq, Maud Velev, Andrea Gallioli, Simone Albisinni, Keiichiro Mori, Abhinav Khanna, Michael Rink, Margit Fisch, Andrea Minervini, Peter C. Black, Yair Lotan, Philippe E. Spiess, Bernhard Kiss, Shahrokh F. Shariat, and Benjamin Pradere Markus von DeimlingMarkus von Deimling , Laura S. MertensLaura S. Mertens , Marc FurrerMarc Furrer , Roger LiRoger Li , Guus A. H. TendijckGuus A. H. Tendijck , Jacob TaylorJacob Taylor , Felice CrocettoFelice Crocetto , Moritz MaasMoritz Maas , Andrea MariAndrea Mari , Renate PichlerRenate Pichler , Marco MoschiniMarco Moschini , Karl H. TullyKarl H. Tully , David D'AndreaDavid D'Andrea , Ekaterina LaukhtinaEkaterina Laukhtina , Francesco Del GiudiceFrancesco Del Giudice , Gautier MarcqGautier Marcq , Maud VelevMaud Velev , Andrea GallioliAndrea Gallioli , Simone AlbisinniSimone Albisinni , Keiichiro MoriKeiichiro Mori , Abhinav KhannaAbhinav Khanna , Michael RinkMichael Rink , Margit FischMargit Fisch , Andrea MinerviniAndrea Minervini , Peter C. BlackPeter C. Black , Yair LotanYair Lotan , Philippe E. SpiessPhilippe E. Spiess , Bernhard KissBernhard Kiss , Shahrokh F. ShariatShahrokh F. Shariat , and Benjamin PradereBenjamin Pradere View All Author Informationhttps://doi.org/10.1097/01.JU.0001008768.36634.79.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with clinically lymph node-positive (cN+) bladder cancer (BCa) are generally treated with induction chemotherapy. However, little is known regarding the optimal number of cycles needed to achieve pathological response and long-term survival in this particular cohort. METHODS: We included 388 patients who received three or four cycles of cisplatin/gemcitabine or (dose-dense) MVAC, followed by consolidative radical cystectomy for cTanyN1-3M0 BCa. We compared pathological complete (pCR=ypT0N0) and objective response (pOR=yp≤T1N0) between treatment groups. The secondary endpoints were overall (OS) and cancer-specific survival (CSS). We identified predictors of pCR and/or pOR on uni- and multivariable logistic regression analysis and evaluated the association between the number of induction chemotherapy cycles administered and survival outcomes on uni- and multivariable Cox regression. RESULTS: A total of 388 patients with non-progressive disease following induction chemotherapy who underwent RC were available for analysis of treatment response and 382 for survival analysis. Overall, 234 (60%) and 128 (33%) patients presented with cN1- or cN2-stage on clinical imaging, respectively. The majority of patients had ≥cT2 disease (n=366 94%). Gemcitabine/cisplatin was the most commonly used regimen (n=269 69%). In total, 101 and 287 patients received three or four cycles of induction chemotherapy, respectively. Of these, 72 (19%; 95%CI 15-23) and 128 (33%; 95%CI 28-38) achieved pCR and pOR response, respectively. pCR (20%, 18%) and pOR (40%, 31%) rates did not differ significantly between patients receiving three or four cycles (p>0.05). The number of cycles was not associated with pCR or pOR on multivariable logistic regression analyses. Two-year OS estimates were 63% (95%CI: 0.53-0.74) and 63% (95%CI: 0.58-0.7) for patients receiving three or four cycles, respectively. Receiving three versus four cycles was not associated with OS and CSS on univariable and multivariable Cox regression analyses. CONCLUSIONS: Pathological response and survival outcomes did not differ between administering three or four cycles in cN+Bca patients. A lower number of cycles (minimum three) may be oncologically sufficient in patients with cN+BCa, while also reducing the risk of adverse events and decreasing the wait for definitive local therapy in those patients who end up without a response to chemotherapy. This warrants further validation. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e723 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Markus von Deimling More articles by this author Laura S. Mertens More articles by this author Marc Furrer More articles by this author Roger Li More articles by this author Guus A. H. Tendijck More articles by this author Jacob Taylor More articles by this author Felice Crocetto More articles by this author Moritz Maas More articles by this author Andrea Mari More articles by this author Renate Pichler More articles by this author Marco Moschini More articles by this author Karl H. Tully More articles by this author David D'Andrea More articles by this author Ekaterina Laukhtina More articles by this author Francesco Del Giudice More articles by this author Gautier Marcq More articles by this author Maud Velev More articles by this author Andrea Gallioli More articles by this author Simone Albisinni More articles by this author Keiichiro Mori More articles by this author Abhinav Khanna More articles by this author Michael Rink More articles by this author Margit Fisch More articles by this author Andrea Minervini More articles by this author Peter C. Black More articles by this author Yair Lotan More articles by this author Philippe E. Spiess More articles by this author Bernhard Kiss More articles by this author Shahrokh F. Shariat More articles by this author Benjamin Pradere More articles by this author Expand All Advertisement PDF downloadLoading ...