Neoadjuvant Chemo for Invasive Bladder Cancer Prolongs Survival, Well Tolerated
This study is based on previous data that demonstrated neoadjuvant chemotherapy (NAC) regimens containing cisplatin-based combinations prolong survival in patients with muscle-invasive bladder cancer (MIBC). However, these studies were neither controlled nor randomized and, thus, optimum regimen management is unknown.
“Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (AMVAC) is a dose-intense regimen that has the potential to minimize delays to definitive, potentially curative therapy,” the investigators wrote.
In this study, the investigators aimed to demonstrate the efficacy and toxicity of AMVAC as NAC in patients with MIBC. To meet this aim, 80 consecutive patients were treated with 3 or 4 cycles of AMVAC (methotrexate 30mg/m2, vinblastine 3mg/m2, doxorubicin 30mg/m2, and cisplatin 70mg/m2) administered at 2-week intervals, with granulocyte colony-stimulating factor support, prior to either radical surgery or radical radiotherapy.
Upon completing their AMVAC regimens, pathological complete response was observed in 43% of 60 surgical patients, with an objective radiological local response observed in 83% of 57 evaluable patients. The more important efficacy results came in the form of 2-year disease-free and overall survival outcomes, which were 65% and 77%, respectively.
Unfortunately, with improved response to therapy came grade 3/4 toxicities, which were observed in “26% of the 42% of patients for whom toxicity data were available, including 12% grade 3/4 neutropenia,” the investigators wrote.
“AMVAC—a safe, well-tolerated and effective NAC regimen for MIBC—minimizes delays to definitive treatment and produces excellent pathological and radiological response rates, making it an appropriate comparator for future randomized trials,” the investigators concluded.