Implications for Efficacy and Safety of Total Dose and Dose-Intensity of Neoadjuvant Gemcitabine-Cisplatin in Muscle-Invasive Bladder Cancer: Three-Week Versus Four-Week Regimen

BACKGROUND: Neoadjuvant cisplatin-based chemotherapy is standard care prior to radical cystectomy in patients with muscle-invasive bladder cancer (MIBC). OBJECTIVE: To assess efficacy and safety of two commonly used neoadjuvant schedules different total doses dose-intensities gemcitabine cisplatin (GC). METHODS: Data were collected retrospectively from all treated between 2010 2018 according clinical routine at seven centres Sweden Denmark. Patients received three cycles a 4-week schedule (GC-4w: 70 mg/m2 day 1, 1000 days 8, 15, q 28 days) Denmark four 3-week (GC-3w: 21 days). Primary endpoint was pathological response (pT0N0 < pT2N0). RESULTS: A 251 GC-4w 455 GC-3w. pT0N0 significantly higher for GC-3w compared GC-4w, 46% versus 32% (adjusted odds ratio [aOR] 1.80; 95% confidence interval [CI] 1.16–2.80; P = 0.009); pT2N0 60% 47% (aOR 1.08; CI 0.70–1.66; 0.743). There no significant differences regarding survival parameters. discontinued treatment more frequently showed degree neutropenia. CONCLUSIONS: complete response-rate observed the patient group cisplatin-dose-intense schedule. The side-effect profile favor approach while relapse-free overall similar.