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

Abstract: 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.

 Fuente: Clinical and Translational Oncology, 2024, 26, 549-553

 Editorial: Springer-Verlag Italia

 Año de publicación: 2024

 Nº de páginas: 5

 Tipo de publicación: Artículo de Revista

 DOI: 10.1007/s12094-023-03277-4

 ISSN: 1699-048X,1699-3055

 Url de la publicación: https://doi.org/10.1007/s12094-023-03277-4

Autoría

MARINA SERRANO FERNANDEZ

NEREA MUÑOZ UNCETA

LUCIA ANDREA ALONSO BUZNEGO

AINARA AZUETA ETXEBARRIA

FERREIRA, LAURA

MARIO DOMINGUEZ ESTEBAN

TORRES ZURITA, ALBERO

ROBERTO BALLESTERO DIEGO

CACHO, DIEGO

LÓPEZ-BREA, MARTA

MARTA SOTELO GARCIA

ENRIQUE ALEJANDRO RAMOS BARSELO

DURÁN, IGNACIO