Optimal Number of Induction Chemotherapy Cycles for cN+ Bladder Cancer

What is it about?

This study aimed to investigate the optimal number of induction chemotherapy cycles needed to achieve a pathological response in patients with clinically lymph node-positive (cN+) bladder cancer. A total of 388 patients who received three or four cycles of cisplatin/gemcitabine or (dose-dense) methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), followed by consolidative radical cystectomy for cTanyN1-3M0 BCa were included. The study found no difference in pathological complete response (pCR) and pOR rates, as well as the 2- and 3-year overall survival (OS) and cancer-specific survival (CSS) rates after treatment with three or four cycles of induction chemotherapy followed by RC with pelvic lymph node dissection. Response rates to preoperative chemotherapy in BCa differ across the literature, with pathological response rates to preoperative chemotherapy at RC being lower than in the neoadjuvant setting. In conclusion, a more restrictive use of induction chemotherapy with fewer cycles and timelier RC may be sufficient to achieve acceptable response rates in cN+ BCa.

Featured Image

Why is it important?

This research is important because it investigates the optimal number of induction chemotherapy cycles needed to achieve a pathological response in patients with clinically lymph node-positive (cN+) bladder cancer who received three or four cycles of induction chemotherapy followed by consolidative radical cystectomy (RC) with pelvic lymph node dissection. Understanding the optimal number of cycles can help in minimizing the side-effects and adverse events associated with aggressive chemotherapy while achieving similar oncological outcomes. Key Takeaways: 1. A retrospective cohort study including 388 patients with clinically lymph node-positive (cN+) bladder cancer who received three or four cycles of induction chemotherapy followed by consolidative radical cystectomy (RC) with pelvic lymph node dissection found no significant difference in pathological complete (pCR) and objective response (pOR) rates between patients who received three or four cycles of induction chemotherapy. 2. The study also found no association between the number of induction chemotherapy cycles and survival outcomes. 3. The study's findings contribute to the concept of chemotherapy de-escalation in bladder cancer, which aims to minimize the side-effects and adverse events associated with aggressive chemotherapy while achieving similar oncological outcomes.