Journal Article Epublish
PubMed: 39858039 DOI: 10.3390/cancers17020258
Neoadjuvant Accelerated Methotrexate, Vinblastine, Doxorubicin, and Cisplatin Chemotherapy for Muscle-Invasive Urothelial Cancer: Large, Single-Center Analysis of Consecutive Patients' Data.
Cancers (Basel) 17(2)
Authors: Łukasz Kwinta, Kamil Konopka, Krzysztof Okoń, Mateusz Łobacz, Piotr Chłosta, Przemysław Dudek, Anna Buda-Nowak, Paweł Potocki, Piotr J Wysocki
Affiliations
- Oncology Department, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland.
- Clinical Department of Oncology, University Hospital in Krakow, 31-501 Kraków, Poland.
- Pathomorphology Department, Faculty of Medicine, Jagiellonian University Medical College, 31-531 Krakow, Poland.
- Department of Pathomorphology, University Hospital in Krakow, 30-688 Kraków, Poland.
- Urology Department, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Krakow, Poland.
- Clinical Department of Urology and Oncological Urology, University Hospital in Krakow, 30-688 Kraków, Poland.
- Oncology Department, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland. Clinical Department of Oncology, University Hospital in Krakow, 31-501 Kraków, Poland.
Abstract
: Bladder cancer is a significant clinical problem with approximately 500,000 new cases worldwide annually. In approximately 25% of cases, disease is diagnosed at a stage of invasion of the muscle layer of the bladder. The current standard approach in this disease is preoperative chemotherapy followed by radical cystectomy. Dose-dense MVAC (ddMVAC), a two-day chemotherapy regimen, is the reference treatment protocol in this setting. The presented study evaluated the effectiveness and safety of accelerated MVAC (aMVAC) chemotherapy-a one-day regimen given before the resection of the bladder due to muscle-invasive disease. : A retrospective analysis included 119 consecutive patients diagnosed with urothelial muscle-invasive bladder cancer (MIBC) who underwent preoperative chemotherapy with the aMVAC regimen. The planned treatment included 4-6 cycles of preoperative chemotherapy. The analysis of the degree of histopathological response to treatment was based on the three-grade TRG (tumor regression grade) classification. : A complete pathological response (TRG1) was observed in 44 patients (36.7%), and a major pathologic response (<ypT2) was achieved in 58 patients (48.7%). A reduction in the cisplatin dose was associated with a statistically significant decrease in the chance of achieving complete pathologic responses (46.1% vs. 10%, RR for TRG1 = 0.69, = 0.00118). Patients who received at least 4 cycles (compared to ≤3 cycles) of neoadjuvant chemotherapy had a significantly higher chance of achieving a pathological response (partial or complete) to treatment (78.1% vs. 52.2%, RR 0.68, = 0.0374). Administration of at least five cycles of chemotherapy was associated (compared to four cycles) with a significantly higher likelihood of achieving a complete pathological response (63.2% vs. 33.8%, RR = 1.71, = 0.0221). The vast majority of adverse events were in grades 1 and 2, according to CTCAE version 5.0. Only five patients experienced grade 3-4 toxicities. The most common adverse event was anemia, which occurred in 66.3% of patients. : Our real-world data analysis confirms the activity, safety, and feasibility of the aMVAC regimen as neoadjuvant chemotherapy in patients with urothelial MIBC.
MeSH
Urinary Bladder, Urinary Bladder Neoplasms, Safety, Muscles, Doxorubicin, Neoplasms, Drug Therapy, Drug-Related Side Effects And Adverse Reactions, Vinblastine, Therapeutics, Methotrexate, Chemotherapy