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Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer

BACKGROUND: There are currently no guideline recommendations regarding the treatment of cisplatin-ineligible, clinically lymph node–positive (cN+) bladder cancer (BCa). OBJECTIVE: To investigate the oncological efficacy of gemcitabine/carboplatin induction chemotherapy (IC) in comparison to cisplati...

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Autores principales: von Deimling, Markus, Mertens, Laura S., van Rhijn, Bas W.G., Lotan, Yair, Spiess, Philippe E., Daneshmand, Siamak, Black, Peter C., Pallauf, Maximilian, D'Andrea, David, Moschini, Marco, Soria, Francesco, Del Giudice, Francesco, Afferi, Luca, Laukhtina, Ekaterina, Yanagisawa, Takafumi, Kawada, Tatsushi, Teoh, Jeremy Y.-C., Abufaraj, Mohammad, Ploussard, Guillaume, Roumiguié, Mathieu, Karakiewicz, Pierre I., Babjuk, Marko, Gontero, Paolo, Xylinas, Evanguelos, Rink, Michael, Shariat, Shahrokh F., Pradere, Benjamin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175724/
https://www.ncbi.nlm.nih.gov/pubmed/37187719
http://dx.doi.org/10.1016/j.euros.2023.02.014
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author von Deimling, Markus
Mertens, Laura S.
van Rhijn, Bas W.G.
Lotan, Yair
Spiess, Philippe E.
Daneshmand, Siamak
Black, Peter C.
Pallauf, Maximilian
D'Andrea, David
Moschini, Marco
Soria, Francesco
Del Giudice, Francesco
Afferi, Luca
Laukhtina, Ekaterina
Yanagisawa, Takafumi
Kawada, Tatsushi
Teoh, Jeremy Y.-C.
Abufaraj, Mohammad
Ploussard, Guillaume
Roumiguié, Mathieu
Karakiewicz, Pierre I.
Babjuk, Marko
Gontero, Paolo
Xylinas, Evanguelos
Rink, Michael
Shariat, Shahrokh F.
Pradere, Benjamin
author_facet von Deimling, Markus
Mertens, Laura S.
van Rhijn, Bas W.G.
Lotan, Yair
Spiess, Philippe E.
Daneshmand, Siamak
Black, Peter C.
Pallauf, Maximilian
D'Andrea, David
Moschini, Marco
Soria, Francesco
Del Giudice, Francesco
Afferi, Luca
Laukhtina, Ekaterina
Yanagisawa, Takafumi
Kawada, Tatsushi
Teoh, Jeremy Y.-C.
Abufaraj, Mohammad
Ploussard, Guillaume
Roumiguié, Mathieu
Karakiewicz, Pierre I.
Babjuk, Marko
Gontero, Paolo
Xylinas, Evanguelos
Rink, Michael
Shariat, Shahrokh F.
Pradere, Benjamin
author_sort von Deimling, Markus
collection PubMed
description BACKGROUND: There are currently no guideline recommendations regarding the treatment of cisplatin-ineligible, clinically lymph node–positive (cN+) bladder cancer (BCa). OBJECTIVE: To investigate the oncological efficacy of gemcitabine/carboplatin induction 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 multivariable 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% confidence 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 single lymph node metastasis may benefit the most.
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spelling pubmed-101757242023-05-13 Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer von Deimling, Markus Mertens, Laura S. van Rhijn, Bas W.G. Lotan, Yair Spiess, Philippe E. Daneshmand, Siamak Black, Peter C. Pallauf, Maximilian D'Andrea, David Moschini, Marco Soria, Francesco Del Giudice, Francesco Afferi, Luca Laukhtina, Ekaterina Yanagisawa, Takafumi Kawada, Tatsushi Teoh, Jeremy Y.-C. Abufaraj, Mohammad Ploussard, Guillaume Roumiguié, Mathieu Karakiewicz, Pierre I. Babjuk, Marko Gontero, Paolo Xylinas, Evanguelos Rink, Michael Shariat, Shahrokh F. Pradere, Benjamin Eur Urol Open Sci Bladder Cancer BACKGROUND: There are currently no guideline recommendations regarding the treatment of cisplatin-ineligible, clinically lymph node–positive (cN+) bladder cancer (BCa). OBJECTIVE: To investigate the oncological efficacy of gemcitabine/carboplatin induction 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 multivariable 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% confidence 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 single lymph node metastasis may benefit the most. Elsevier 2023-03-25 /pmc/articles/PMC10175724/ /pubmed/37187719 http://dx.doi.org/10.1016/j.euros.2023.02.014 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Bladder Cancer
von Deimling, Markus
Mertens, Laura S.
van Rhijn, Bas W.G.
Lotan, Yair
Spiess, Philippe E.
Daneshmand, Siamak
Black, Peter C.
Pallauf, Maximilian
D'Andrea, David
Moschini, Marco
Soria, Francesco
Del Giudice, Francesco
Afferi, Luca
Laukhtina, Ekaterina
Yanagisawa, Takafumi
Kawada, Tatsushi
Teoh, Jeremy Y.-C.
Abufaraj, Mohammad
Ploussard, Guillaume
Roumiguié, Mathieu
Karakiewicz, Pierre I.
Babjuk, Marko
Gontero, Paolo
Xylinas, Evanguelos
Rink, Michael
Shariat, Shahrokh F.
Pradere, Benjamin
Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer
title Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer
title_full Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer
title_fullStr Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer
title_full_unstemmed Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer
title_short Carboplatin Induction Chemotherapy in Clinically Lymph Node–positive Bladder Cancer
title_sort carboplatin induction chemotherapy in clinically lymph node–positive bladder cancer
topic Bladder Cancer
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175724/
https://www.ncbi.nlm.nih.gov/pubmed/37187719
http://dx.doi.org/10.1016/j.euros.2023.02.014
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