Significance of split-dose cisplatin-based neoadjuvant chemotherapy followed by robotic-assisted radical cystectomy for muscle invasive bladder cancer

Abstract

Background: Although cisplatin is essential for neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC), good renal function is a prerequisite for those patients receiving NAC. However, patients with normal renal function may experience nephrotoxicity after cisplatin administration. We investigated the safety and efficacy of a split-dose regimen of gemcitabine and cisplatin (split-dose GC) in MIBC patients with normal renal function. Methods: This retrospective study included 45 patients with MIBC who received standard GC, split-dose GC, or gemcitabine and carboplatin (GCarbo) as a NAC and subsequently underwent robot-assisted radical cystectomy. The efficacy and safety of two cycles split-dose GC were compared with those of other regimens. Results: Among the 45 patients with MIBC, 14 received standard GC, 14 received split-dose GC, and 17 received GCarbo. Pathological complete response rates were 28.6%, 21.4%, and 29.4% for surgical specimens obtained post-treatment with standard GC, split-dose GC, and GCarbo, respectively (P=0.86). Renal function after NAC was significantly lower in the standard- and split-dose GC groups than in the GCarbo group (P<0.001). Conclusions: Although the split-dose GC regimen showed a significant reduction compared to pre-treatment renal function, the pathological response rate and incidence of adverse events were similar to those of the other two regimens.