Introduction: Muscle invasive bladder cancer has median survival of less than two years. Neoadjuvant chemotherapy is underutilised for management of bladder cancer despite the fact that it decreases the risk of death by 14% and improve absolute disease free survival by 9%.¹

Aim: To study treatment and survival outcomes for neoadjuvant chemotherapy in muscle invasive bladder cancer.

Methods: We reviewed all adult patients who were treated with neoadjuvant chemotherapy for muscle invasive bladder cancer with curative intent between 2009 and 2015. Data were extracted from electronic databases of several cancer centres . Overall survival (OS) and progression free survival (PFS) were examined using Kaplan-Meier survival analysis.

Results: Data from sixteen patients with muscle invasive urothelial bladder cancer were included in the study. The median age of patients was 64.5 years (range 47-76) at time of diagnosis, more men (88%) than women (12%) were enrolled. Half of the patients were performance status (PS) 0 with the remaining PS 1. One fourth of patients (25%) had complete pathological response and 31.25 % had partial response. The median PFS was 458 days (95% CI: 195-689 days). There were six deaths at study cut-off point. Three deaths were due to causes unrelated to bladder cancer. Of the patients who died from disease two were treated with carboplatin and gemcitabine chemotherapy. All other patients (14 of 16; 88%) received cisplatin and gemcitabine chemotherapy. Chemotherapy was tolerated well with low incidence of grade 3 and grade 4 toxicities. No treatment related deaths were observed. The median OS was 785 days (95% CI: 512-1057 days).

Conclusion: Our study reinforces the utility of cisplatin-based neoadjuvant combination chemotherapy for muscle invasive bladder cancer patients. The use of carboplatin-based chemotherapy for patients not suitable for cisplatin is not supported by our limited data.