title: Adjuvant chemotherapy for locally advanced urothelial carcinoma: an overview of the USC experience.
abstract: OBJECTIVE
  To describe the tolerability of two chemotherapy regimens, gemcitabine and cisplatin (GC) and methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) for adjuvant treatment of patients with locally advanced urothelial cancer after radical cystectomy.
  
  
  METHODS
  The USC Department of Urology bladder cancer database was searched for subjects who received adjuvant chemotherapy following cystectomy for transitional cell carcinoma with extravesical and/or lymph node involvement, yielding 187 cases. Clinical details regarding toxicity, number of cycles administered, and cancer outcome were analyzed.
  
  
  RESULTS
  The majority of subjects had lymph node involvement (70%). Sixty-eight percent of subjects received MVAC and 32% received GC, the latter regimen was predominant after 2000. Fifty-six percent of subjects received all four planned cycles (51% GC and 58% MVAC). With a median follow-up of 11.2 years (range 1.9-19.6), 96 patients (51%) have suffered a relapse, with no significant difference between chemotherapy regimens. Median time to recurrence for the population was 3.7 years and median overall survival is 4.6 years (3.0-9.3). The median time from recurrence to death was 6.7 months and was not significantly different between MVAC and GC.
  
  
  CONCLUSIONS
  Both MVAC and GC are tolerated after cystectomy for advanced urothelial carcinoma. A significant proportion of high-risk patients survive, free of disease, beyond 10 years. At recurrence, patients previously treated with adjuvant chemotherapy have a survival that appears much shorter than patients who develop metastases in the absence of this exposure, suggesting resistance to salvage chemotherapy.
authors.affiliation: USC Keck School of Medicine, 1441 Eastlake Avenue, Los Angeles, CA, 90033, USA. dorff@usc.edu
authors.forename: Tanya B
authors.initials: TB
authors.lastname: Dorff
authors.forename: Denice
authors.initials: D
authors.lastname: Tsao-Wei
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Donald G
authors.initials: DG
authors.lastname: Skinner
authors.forename: John P
authors.initials: JP
authors.lastname: Stein
authors.forename: David I
authors.initials: DI
authors.lastname: Quinn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002140:California; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D004317:Doxorubicin / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D014495:Universities; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D014747:Vinblastine / Q000627:therapeutic use; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate; D000093542:Gemcitabine