Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
Clin Genitourin Cancer. 2012 Dec;10(4):246-50. doi: 10.1016/j.clgc.2012.08.004. Epub 2012 Sep 13.
The benefit of neoadjuvant methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) for muscle-invasive bladder cancer (MIBC) has been prospectively demonstrated in a phase III study. Extrapolating from comparative data in the metastatic setting, platinum doublets such as cisplatin-gemcitabine (CG) have been adopted. We sought to compare clinical outcomes in patients treated for MIBC with neoadjuvant CG and MVAC at our institution.
Patients with MIBC were identified from a prospectively maintained registry. Clinicopathologic information and clinical outcome data were obtained directly from the registry. When available, pharmacy records were reviewed to ascertain the use of growth factors and chemotherapy dose intensity (DI). Survival was compared in subgroups divided by the regimen of chemotherapy rendered (ie, CG vs. MVAC) using the Kaplan-Meier method.
Median overall survival (OS) in the overall cohort (N = 61) was 23 months. OS was improved in patients receiving either MVAC or CG chemotherapy compared with patients receiving "other" chemotherapy (35.3 vs. 16.3 months; P = .055). Although the median OS associated with neoadjuvant CG numerically exceeded the survival associated with neoadjuvant MVAC (104.3 and 21.8 months, respectively), this was not statistically significant (P = .73). Pathologic downstaging predicted improved OS with both neoadjuvant CG and MVAC, and the rates of downstaging were similar with both regimens.
Although warranting prospective validation, our data suggest that CG is a possible alternative neoadjuvant approach to traditional regimens such as MVAC for patients with MIBC.
在一项 III 期研究中，前瞻性地证明了新辅助甲氨蝶呤、长春碱、多柔比星（阿霉素）和顺铂（MVAC）对肌层浸润性膀胱癌（MIBC）的益处。根据转移性环境中的比较数据推断，顺铂-吉西他滨（CG）等铂类双联方案已被采用。我们试图比较本机构接受新辅助 CG 和 MVAC 治疗的 MIBC 患者的临床结果。
从一个前瞻性维护的登记处确定 MIBC 患者。从登记处直接获得临床病理信息和临床结果数据。在有条件的情况下，审查药房记录以确定生长因子和化疗剂量强度（DI）的使用情况。使用 Kaplan-Meier 方法根据化疗方案（即 CG 与 MVAC）将患者分为亚组，比较生存情况。
在整个队列（N=61）中，中位总生存期（OS）为 23 个月。与接受其他化疗的患者相比，接受 MVAC 或 CG 化疗的患者 OS 得到改善（35.3 与 16.3 个月；P=.055）。虽然 CG 新辅助化疗的中位 OS 数值上超过了 MVAC 新辅助化疗的生存时间（分别为 104.3 和 21.8 个月），但这没有统计学意义（P=.73）。病理降期与 CG 和 MVAC 新辅助治疗均预测 OS 改善，两种方案的降期率相似。
尽管需要前瞻性验证，但我们的数据表明，CG 可能是 MIBC 患者传统方案（如 MVAC）的一种替代新辅助方法。
