Neoadjuvant induction dose-dense MVAC for muscle invasive bladder cancer: efficacy and safety compared with classic MVAC and gemcitabine/cisplatin

Purpose: To investigate the efficacy and safety of neoadjuvant induction dose-dense MVAC (dd-MVAC) for muscle invasive bladder cancer (MIBC). Results of the 2-week-per-cycle regimen were compared with classic MVAC (4 weeks per cycle) and gemcitabine/cisplatin (GC, 3 weeks per cycle). Methods: We included 166 patients with non-organ-confined MIBC, who received neoadjuvant induction dd-MVAC (80), classic MVAC (35), or GC (51) between 1990 and 2014. Complete pathological response (pCR) was defined as no evidence of residual tumor in cystectomy and lymphadenectomy specimens (ypT0N0). pCR and toxicity rates were compared among regimens. Results: pCR was found in 29 % of dd-MVAC-treated patients, which was not significantly different from classic MVAC (20 %, p = 0.366) and GC (32 %, p = 0.845). Grade 3–4 toxicity rates related to dd-MVAC and GC (44 %) were similar (p = 0.202), whereas the toxicity rate for classic MVAC (55 %) was significantly higher than for dd-MVAC (32 %) uncorrected (p = 0.026) and corrected for patient and tumor characteristics (OR 2.84, p = 0.037). Conclusions: Neoadjuvant induction dd-MVAC resulted in pathological response rates similar to classic MVAC and GC treatment in patients with non-organ-confined MIBC. The shorter cycle duration compared with classic MVAC and GC and the significantly lower toxicity rate compared with classic MVAC indicate that dd-MVAC should be the preferred option for neoadjuvant induction treatment.