A single arm phase II trial of neoadjuvant cabazitaxel and cisplatin chemotherapy for muscle invasive transitional cell carcinoma of the urinary bladder

Amarnath Challapalli, Susan Masson, Paul White, Narges Dailami, Sylvia Pearson, Edward Rowe, Anthony Koupparis, Jon Oxley, Ahmed Abdelaziz, Janice Ash-Miles, Alicia Bravo, Emily Foulstone, Claire Perks, Jeff Holly, Raj Persad, Amit Bahl

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Introduction
Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle-invasive bladder cancer. However, response rates and survival remain suboptimal. We evaluated the efficacy, safety, and tolerability of cisplatin plus cabazitaxel.

Methods
A phase II single-arm trial was designed to recruit at least 26 evaluable patients. This would give 80% power to detect the primary endpoint, an objective response rate defined as a pathologic complete response plus partial response (pathologic downstaging), measured by pathologic staging at cystectomy (p0 = 0.35 and p1 = 0.60, α = 0.05).

Results
Objective response was seen in 15 of 26 evaluable patients (57.7%) and more than one- third of patients achieved a pathologic complete response (9/26; 34.6%). Seventy-eight percent of the patients (21/27) completed all cycles of treatment, with only 6.7% of the reported adverse events being graded 3 or 4. There were 6 treatment-related serious adverse event reported, but no suspected unexpected serious adverse reactions. In the patients who achieved an objective response, the median progression-free survival and overall survival were not reached (median follow-up of 41.5 months). In contrast, the median progression-free survival (7.2 months) and overall survival (16.9 months) were significantly worse (P = .001, log-rank) in patients who did not achieve an objective response.

Conclusion
Cabazitaxel plus cisplatin for neoadjuvant treatment of muscle-invasive bladder cancer can be considered a well-tolerated and effective regimen before definitive therapy with higher rates (57.7%) of objective response, comparing favorably to that with of cisplatin/gemcitabine (23%–26%). These results warrant further evaluation in a phase III study.
Original languageEnglish
JournalClinical Genitourinary Cancer
Early online date18 Feb 2021
DOIs
Publication statusE-pub ahead of print - 18 Feb 2021

Bibliographical note

Funding Information:
The authors acknowledge the support of Sanofi Genzyme for funding the study via a grant and for supplying cabazitaxel. The funder had no role in the study design, collection, analysis, and interpretation of data; in the writing of the manuscript; the funder reviewed and approved the decision to submit the manuscript for publication. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Publisher Copyright:
© 2021

Keywords

  • neoadjuvant chemotherapy
  • pathologic complete response
  • bladder cancer
  • radical cystectomy
  • adverse events

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