Is neoadjuvant chemotherapy with gemcitabine plus cisplatin beneficial in patients with muscle-invasive bladder cancer?
Evaluation of: Weight CJ, Garcia JA, Hansel DE et al. Lack of pathologic down-staging with neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma of the bladder. Cancer 115, 792-799 (2009). This study by the Glickman Urological Institute fails to show a beneficial role for neoadjuvant chemotherapy in muscle-invasive bladder cancer. The poor outcomes in the study could be attributed to the use of non-methotrexate, vinblastine, doxorubicin and cisplatin regimens and to excessive delays in performing cystectomy. Randomized trials of neoadjuvant chemotherapy have shown improved survival and increased rates of pathologic complete response when using cisplatin-based combination therapies compared with local therapy alone. A regimen consisting of gemcitabine plus cisplatin has shown similar efficacy and less toxicity in the metastatic setting and further research is warranted before its efficacy can be extrapolated to the neoadjuvant setting.
Yafi
Faysal A
FA
Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada. faysal.yafi@mail.mcgill.ca
Kassouf
Wassim
W