The Combination of Gemcitabine and Carboplatin in Neoadjuvant Treatment of Bladder Cancer: A Pilot Study

The toxicity of cisplatin precludes its use in patients with bladder cancer with abnormal renal function tests or poor performance status, thus carboplatin may be used as a substitute. In this study, we evaluated retrospectively the patients treated with neoadjuvant gemcitabine-carboplatin (GCb) in our clinic to assess the efficacy and toxicity of this regimen. Patients with localized muscle invasive bladder cancer were treated with 3 cycles of gemcitabine (1000 mg/m(2) days 1, 8 q3w) and carboplatin (AUC=4 according to the Calvert formula, day 1, q3w) combination and were subsequently operated. Response rates in terms of pathological complete response (pCR) and safety issues were assessed. Fourteen patients were evaluated. Median age of the patients was 62 (range 55-79) and all were males. Median creatinine clearance was 51 ml/min (range 2972 ml/min). Nine patients completed 3 cycles of chemotherapy while 2 patients received 2 cycles and 3 patients received 1 cycle. The treatment was generally well tolerated. Grade 3/4 neutropenia developed in 4 patients (29%) and grade 3/4 thrombocytopenia developed in 3 patients (21%). One patient developed febrile neutropenia. Afetr surgery, pCR was achieved in one patient (7% of whole group). The median interval between the last dose of neoadjuvant chemotherapy and the time of surgery was 45 days (range 17-106 days) and this interval was significantly correlated with post-operative pathological T stage of the tumor (r=0.844, p=0.017). Gemcitabine-carboplatin combination represents a feasible alternative to gemcitabine-cisplatin regimen with moderate activity and favorable toxicity profile. Shorter interval between the completion of chemotherapy and the time of surgery was associated with higher rates of response.