von Deimling, Markus and Mertens, Laura S. and van Rhijn, Bas W. G. and Lotan, Yair and Spiess, Philippe E. and Daneshmand, Siamak and Black, Peter C. and Pallauf, Maximilian and D'Andrea, David and Moschini, Marco and Soria, Francesco and Del Giudice, Francesco and Afferi, Luca and Laukhtina, Ekaterina and Yanagisawa, Takafumi and Kawada, Tatsushi and Teoh, Jeremy Y. -C. and Abufaraj, Mohammad and Ploussard, Guillaume and Roumiguie, Mathieu and Karakiewicz, Pierre I. and Babjuk, Marko and Gontero, Paolo and Xylinas, Evanguelos and Rink, Michael and Shariat, Shahrokh F. and Pradere, Benjamin (2023) Carboplatin Induction Chemotherapy in Clinically Lymph Node-positive Bladder Cancer. EUROPEAN UROLOGY OPEN SCIENCE, 51. pp. 39-46. ISSN 2666-1691, 2666-1683
Full text not available from this repository. (Request a copy)Abstract
Background: There are currently no guideline recommendations regarding the treatment of cisplatin-ineligible, clinically lymph node-positive (cN+) bladder can-cer (BCa).Objective: To investigate the oncological efficacy of gemcitabine/carboplatin induc-tion chemotherapy (IC) in comparison to cisplatin-based regimens in cN+ BCa. Design, setting, and participants: This was an observational study of 369 patients with cT2-4 N1-3 M0 BCa.Intervention: IC followed by consolidative radical cystectomy (RC). Outcome measurements and statistical analysis: The primary endpoints were the pathological objective response (pOR; ypT0/Ta/Tis/T1 N0) rate and the pathological complete response (pCR; ypT0N0) rate. We applied 3:1 propensity score matching (PSM) to reduce selection bias. Overall survival (OS) and cancer-specific survival (CSS) were compared across groups using the Kaplan-Meier method. Associations between the treatment regimen and survival endpoints were tested in multivari-able Cox regression analyses. Results and limitations: After PSM, a cohort of 216 patients was available for analysis, of whom 162 received cisplatin-based IC and 54 gemcitabine/carboplatin IC. At RC, 54 patients (25%) had a pOR and 36 (17%) had a pCR. The 2-yr CSS was 59.8% (95% con-fidence interval [CI] 51.9-69%) for patients who received cisplatin-based IC versus 38.8% (95% CI 26-57.9%) for those who received gemcitabine/carboplatin. For the pOR (p = 0.8), ypN0 status at RC (p = 0.5), and cN1 BCa subgroups (p = 0.7), there was no difference in CSS between cisplatin-based IC and gemcitabine/carboplatin. In the cN1 subgroup, treatment with gemcitabine/carboplatin was not associated with shorter OS (p = 0.2) or CSS (p = 0.1) on multivariable Cox regression analysis.Conclusions: Cisplatin-based IC seems to be superior to gemcitabine/carboplatin and should be the standard for cisplatin-eligible patients with cN+ BCa. Gemcitabine/carboplatin may be an alternative treatment for selected cisplatin-ineligible patients with cN+ BCa. In particular, selected cisplatin-ineligible patients with cN1 disease may benefit from gemcitabine/carboplatin IC.Patient summary: In this multicenter study, we found that selected patients with bladder cancer and clinical evidence of lymph node metastasis who cannot receive standard cisplatin-based chemotherapy before surgery to remove their bladder may benefit from chemotherapy with gemcitabine/carboplatin. Patients with a sin-gle lymph node metastasis may benefit the most.(c) 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CISPLATIN-BASED CHEMOTHERAPY; RADICAL CYSTECTOMY; UROTHELIAL CARCINOMA; OUTCOMES; UNFIT; TRIAL; IMMUNOTHERAPY; METHOTREXATE; GEMCITABINE; VINBLASTINE; Carboplatin; Induction chemotherapy; Oligometastatic; Survival; Urinary bladder neoplasms |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 30 Jan 2024 07:29 |
| Last Modified: | 30 Jan 2024 07:29 |
| URI: | https://pred.uni-regensburg.de/id/eprint/60939 |
Actions (login required)
 |
View Item |
