The effects of multidisciplinary therapies surgery plus Gemcitabine, Cisplatin and Paclitaxel (GCP) chemotherapy, against advanced urothelial carcinoma

Combination chemotherapy with Gemcitabine, Cisplatin and Paclitaxel (GCP) is an active and well-tolerated combination for the treatment of advanced urothelial carcinoma. There is no evidence that multidisciplinary therapy, surgery plus GCP chemotherapy, can improve survival for patients with advanced urothelial carcinoma. We retrospectively analyzed the tolerability and efficacy of multidisciplinary therapy, surgery plus GCP chemotherapy, against advanced urothelial carcinoma. In this institution, patients (pts) with histologically verified advanced urothelial carcinoma received 2-4 cycles of gemcitabine 1,200 mg/m² on days 1 and 8, cisplatin 70 mg/m² on day 1, and paclitaxel 80 mg/m² on days 1 and 8 prior or subsequent to surgery. Radiologic response was evaluated with computed tomography and magnetic resonance imaging. Between May 2003 and Oct 2007, 19 pts (8 pts as neoadjuvant therapy (group A) and 11 as adjuvant therapy (group B)) were analyzed. Median age was 57 years. All pts had Performance Status 0 or 1. Initial TNM stage was T3-4 NO M0 in 5, T any N1-2 M0 in 9 and T any N any M1 in 5 pts. The chemotherapy was well tolerated with infrequent grade III/ IV toxicity (neutropenia in 6 and anemia in 2, thrombocytopenia in 4 patients). Median follow-up was 18 months (4-47). By Oct 2007, 18 pts had undergone radical surgery (9 pts radical cystectomy, 8 pts nephroureterectomy, and 1 pt retroperitoneal lymph node dissection). In group A, the radiologic response rate was documented in 6 out of 8 accessible pts (75%), including 1 complete response (CR) and 1 pathological CR. Two out of 8 pts (25%) relapsed and died. In group B, 6 pts out 11 (55%) relapsed and 2 (18%) died of the cancer. Median estimated progression-free survival and median overall survival were 15.4 months and 19.9 months respectively. Multidisciplinary therapy, surgery plus GCP chemotherapy, is effective and tolerable even in cases of metastastic urothelial carcinoma. A longer follow-up period is necessary in order to evaluate its impact on the overall survival of these pts.