Neoadjuvant Dose Dense Gemcitabine and Cisplatin (DD GC) In Patients With Muscle-Invasive Bladder Cancer

Inclusion Criteria:

- Muscle invasive urothelial carcinoma of the bladder histologically confirmed at MSKCC
or participating site ((Urothelial carcinoma invading into the prostatic stroma with
no histologic muscle invasion is allowed, provided the extent of disease is confirmed
via imaging and/or EUA.)

- Clinical stage T2-T4a N0/X M0 disease

- Medically appropriate candidate for radical cystectomy, as per MSKCC or participating
site

- Karnofsky Performance Status ≥ 70%

- Age ≥ 18 years of age

- Required Initial Laboratory Values:

- Absolute Neutrophil Count ≥ 1000 cells/mm3

- Platelets ≥ 100,000 cells/mm3

- Hemoglobin ≥ 9.0g/dL

- Bilirubin ≤ 1.5 the upper limit of normal (ULN) for the institution

- Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 2.5 x ULN for the
institution

- Alkaline phosphatase ≤ 2.5 x ULN for the institution

- Serum creatinine ≤ 1.5 mg/dL

- Estimated glomerular filtration rate ≥ 60 ml/min/1.73m2 using the CKD-EPI equation:
eGFR = 141 x min(Scr/k, 1)a x max(Scr/k, 1)-1.209 x 0.993Age

- x 1.018 [if female] x 1.159 [if black] Scr is serum creatinine, k is 0.7 for females
and 0.9 for males, a is -0.329 for females and -0.411 for males, min indicates the
minimum of Scr/k or 1, and max indicates the maximum of Scr/k or 1

- If female of childbearing potential, pregnancy test is negative

Exclusion Criteria:

- Prior systemic chemotherapy (prior intravesical therapy is allowed)

- Prior radiation therapy to the bladder

- Evidence of NYHA functional class III or IV heart disease

- Serious intercurrent medical or psychiatric illness, including serious active
infection

- Preexisting sensory grade ≥ 2 neuropathy

- Preexisting grade ≥ 2 hearing loss

- Major surgery or radiation therapy < 4 weeks of starting study treatment

- Concomitant use of any other investigational drugs

- Any of the following within the 6 months prior to study drug administration:
myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass
graft, symptomatic congestive heart failure, cerebrovascular accident, or transient
ischemic attack

- Ongoing cardiac dysrhythmias of NCI CTCAE Version 4.0 grade ≥ 2

- Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome
(AIDS)-related illness or other active infection

- Concurrent treatment on another clinical trial; supportive care trials or
non-treatment trials, e.g. QOL, are allowed

- Pregnancy or breast-feeding. Patients must be surgically sterile, postmenopausal, or
must agree to use effective contraception during the period of therapy. The definition
of effective contraception will be based on the judgment of the principal investigator
or a designated associate. Male patients must be surgically sterile or agree to use
effective contraception.