title: Nonresponse to neoadjuvant chemotherapy for muscle-invasive urothelial cell carcinoma of the bladder.
abstract: BACKGROUND
  Cisplatin-based neoadjuvant chemotherapy (NC) is commonly used in the treatment of muscle-invasive urothelial cell carcinoma of the bladder (UC) and has been shown to improve survival. However, not all patients respond to NC, thus delaying the interval to potentially curative surgical therapy, risking disease progression and subjecting patients to potential morbidity from NC. In this study, we perform a retrospective analysis of patients who received NC prior to cystectomy to identify factors associated with nonresponse.
  
  
  METHODS
  We identified 80 patients with clinical T2 to T4, N0 to N1 UC of the bladder who received NC and underwent radical cystectomy. Nonresponse was defined as patients with higher pathologic T stage than clinical stage or patients with nodal involvement identified on final pathology.
  
  
  RESULTS
  Overall, 20% of patients were considered nonresponders. In multivariate analysis, age was predictive of nonresponse (P(trend) < .05). Compared with those < 60 years of age, those aged 60 to 69 years (odds ratio [OR], 2.9; 95% CI, 0.7-12) and those aged ≥ 70 (OR, 5.0; 95% CI, 0.9-28) had higher odds of nonresponse. Patients who received gemcitabine-carboplatin had higher odds of nonresponse compared with those who received gemcitabine-cisplatin (OR, 4.4; 95% CI, 0.8-21).
  
  
  CONCLUSIONS
  A subset of patients receiving NC prior to cystectomy will experience disease progression. Future study will need to better identify methods to distinguish individuals more likely to benefit from NC and those that should receive upfront cystectomy.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA. Electronic address: matthewmossanen@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mossanen
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Franklin
authors.initials: F
authors.lastname: Lee
authors.affiliation: Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Heather
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA.
authors.forename: William
authors.initials: W
authors.lastname: Harris
authors.affiliation: Group Health, Seattle, WA.
authors.forename: Jaideep
authors.initials: J
authors.lastname: Shenoi
authors.affiliation: Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Song
authors.initials: S
authors.lastname: Zhao
authors.affiliation: University of Utah, Salt Lake City, UT.
authors.forename: Junfeng
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Champion
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Jason
authors.initials: J
authors.lastname: Izard
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Porter
authors.affiliation: Department of Medicine, Division of Oncology, University of Washington School of Medicine, Seattle, WA.
authors.forename: Evan Y
authors.initials: EY
authors.lastname: Yu
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Wright
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
keywords: Cisplatin; Cystectomy; Muscle-invasive; Nonresponse; Urothelial cell cancer