前導性化療結合免疫治療後行根治性膀胱切除術-中國醫藥大學附設醫院的初步結果
楊有容、黃志平、1林精湛、陳冠亨、蕭博任、張兆祥
中國醫藥大學附設醫院 泌尿部，1血液腫瘤部
Neoadjuvant chemotherapy combined with immunotherapy followed by radical cystectomy-Preliminary results in CMUH.
You-rong Yang, Chi-ping Huang, 1 Ching-Chan Lin, Guang-heng Chen, Po-jen Hsiao, Chao-hsiang Chang
Department of Urology and 1 Oncology, China Medical University Hospital, Taichung, Taiwan
Purpose: Radical cystectomy (RC) alone for muscle-invasive bladder cancer (MIBC) is insufficient and it is associated with a high rate of cancer-specific mortality. Neoadjuvant chemotherapy (NAC) in MIBC improves survival at RC. Both NAC and Immunotherapy gives benefit to response rate in studies, combined use of NAC and immunotherapy maybe has synergistic effect in response rate and survival. We share our experience and preliminary results of chemotherapy combined with immunotherapy followed by radical cystectomy.
Materials and Methods: Patients with MIBC eligible for neoadjuvant chemotherapy and planned for RC between January 2017 and March 2020 was included. Patient characteristics, Clinical course, drugs, and pathologic response were evaluated. Meanwhile the safety of combination of chemotherapy and immunotherapy in patients with MIBC prior to RC will be mentioned.
Results: 12 patients have been enrolled. All of the NAC was Gemcitabine and platinum-based drugs. Six patients received the combination of Durvalumab, five Nivolumab, and one Pembrolizumab. Pathologic downstage was observed in 9(75%) patients, and 6 of them was ypT0N0. However, 3 patients had no response to the neoadjuvant therapy according to the pathologic results. The medium fallow time was 157 days. And the average time from the end of neoadjuvant therapy to surgery was 24.4 days. The combination has not resulted in any add toxicity or mortality so far.
Conclusions: Neoadjuvant chemotherapy combined with immunotherapy is safe and effective treatment for MIBC according to the current study. We need more time and data to confirm whether this therapy gives more benefit to the overall survival for the patients, further enrollment and evaluation is ongoing.