A community hospital experience in the use of peri-operative dose-dense MVAC in patients with muscle-invasive bladder cancer (MIBC) treated with either robotic cystectomy (RC) or open cystectomy (OC).

Background:  Community practices have shied away in using DD-MVAC as neo-adjuvant regimen of choice to treat MIBC. Recent data has shown that DD-MVAC has better tolerability than standard MVAC and its use has now being advocated in the neo-adjuvant setting. Most recently, RC has also risen as a reasonable alternative to OC for MIBC. The objective of our retrospective study was to evaluate pathological Complete Response(pCR), the impact on disease-free survival (DFS), overall survival(OS), and toxicity adverse events of DD-MVAC treated with RC or OC.  Methods:  An institutional database of a total of 16 patients (pts) with MIBC was reviewed in an IRB approved fashion. Eligible pts were treated with peri-operative chemotherapy using DD-MVAC q 14 days for 3-4 cycles plus cystectomy between 04/2011 and 01/2014. DD-MVAC therapy consisted of 30 mg/m 2 methotrexate, cisplatin 70 mg/m2, doxorubicin 30 mg/m2 and vinblastine 3 mg/m2 on day 1 and pegylated GCSF 6 mg sq on day 2. The choice of either RC or OC was per surgeon’s discretion.  Results:  The average age was 63.5 years old. 10 pts received neo-adjuvant DD-MVAC and 2 patients received DD-MVAC post-operatively. 50% received 3 cycles DD-MVAC, 50% received 4 cycles. 58% of the cohort had T2 stage and 42% had T3 stage. 42% of the cohort underwent RC and 58% underwent OC. The average hospital stay in days was 5.6 for RC and 8.3 for OC. From the 10 pts who received neo-adjuvant DD-MVAC, 50% had a pCR. The DFS & OS were both 92%. The only patient who has progressed and died had micropapillary type histology. Grade 3 or 4 toxicities include: Anemia (25%), Fatigue (17%), Hypomagnesemia (8%).  Conclusions:  Although this is not a randomized study, peri-operative DD-MVAC plus cystectomy is very effective and well tolerated and may be associated with improved survival among patients with MIBC. The use of RC shorten the duration of hospital days and did not negatively impact on the OS or PFS. This data needs to be confirmed by randomized clinical trials.