Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience

• Marina Serrano ^[1] ; Nerea Muñoz-Unceta ^[1] ; Lucía Andrea Alonso ^[1] ; Ainara Azueta ^[2] ; José Luis Gutiérrez Baños ^[3] ; Laura Ferreira ^[4] ; Mario Domínguez ^[3] ; Albero Torres Zurita ^[5] ; Roberto Ballestero ^[3] ; Diego Cacho ^[1] ; Marta López-Brea ^[1] ; Marta Sotelo ^[1] ; Félix Campos-Juanatey ^[3] ; Enrique Ramos Barseló ^[3] ; Ignacio Duran ^[1]
  1. [1] Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
  2. [2] Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
  3. [3] Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
  4. [4] Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
  5. [5] Medical Oncology Department, Hospital Universitario Virgen Macarena, Seville, Spain

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 26, Nº. 2, 2024, págs. 549-553
• Idioma: inglés
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• Resumen

  • Purpose Neoadjuvant chemotherapy in muscle-invasive bladder cancer (MIBC) patients has proven beneficial in overall survival. However, the optimal regimen is still a matter of debate.

    Materials and methods In this retrospective analysis, we evaluate the results obtained in 42 patients treated in our center with 4 cycles of neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) followed by radical cystectomy from August 2015 to October 2020. All patients had cT2 or higher non-metastatic MIBC. Clinical and pathological outcomes are reported.

    Results Of the 42 patients, 90.5% were men (n = 38) and the mean age was 65 years. All of them had ECOG 0–1 at diagnosis and most tumors had an initial clinical stage T2N0 (76%). Thirty-six patients (85.7%) completed 4 cycles of neoadjuvant treatment, and 21.4% required a dose reduction. The most frequent adverse event (AE) was grade 1–2 asthenia (81%), while neutropenia was the most frequent grade 3 or higher AE (38%). Complete pathological response (ypT0, ypN0) was achieved in 50% of patients (n = 21), and down-staging was observed in 57.1% (n = 24). Only one patient presented radiological progressive disease during neoadjuvant treatment (2.4%), and after a mean follow-up time of 31.5 months, 33.3% of patients experienced disease recurrence.

    Conclusions Neoadjuvant chemotherapy with 4 cycles of dd-MVAC is an effective regimen with high rates of pathological complete responses and down-staging along with an acceptable toxicity profile. DD-MVAC should be considered as an alternative to cisplatin and gemcitabine in patients with good clinical performance status.