Effectiveness and response predicition of pre-emptive modified CMV chemotherapy in invasive transitional cell carcinoma of the urinary bladder

ABSTRACT

The effectiveness of pre-emptive [neoadjuvant] chemotherapy and prediction of tumor response were explored in 79 patients who had inasive transitional cell carcinoma [T. C. C.] of the urinary bladder in a prospective study. Patients were blindly randomized into 2 groups. Arm I included 35 patients who received 2 cycles of paraplatin, methotrexate and vinblastine [P. M. V] prior to radical cystectomy. While in arm II, 44 patients had radical cystectomy alone. The effectiveness of P.M.V. in relation to tumour cell type, stage, regional lymph nodal involvement, and D. N. A. ploidy were studied. Following P. M. V. complete response [CR] was achieved in 48% of patients who had pure T. C. C. while mixed tumors had no CR. pathologic down staging [PDS] was documented in 29% of arm I and 5% of arm II patients [p < 0.05]; Locoregional lymph nodal spread was evident among arm I and II patients in 3 and 14% respectively. [P > 0.05] D. N. A. ploidy in relation to tumour response was studied using rapid flow cytometry technique in bladder wash outs before initiation of treatment and before cystectomy in arm I patients. Aneuploid tumors responded better than diploid ones. Moreover, favourable response was associated with a shift to diploid pattern. In conclusion, P. M. V is highly effective against pure T. C. C. it had PDS in almost one third of patients who received neoadjuvant chemotherapy. Moreover, in this particular group of patients, the leco-regional lymph node involvement dropped to only 3%. We beleive that D. N. A. ploidy may become a clinically usefull predictor for positive chemotherapeutic response and consequently, it identifies certain sub-population of patients who must be suitable for neoadjuvant chemotherapy in insasive T.C.C. of the urinary bladder