Neoadjuvant Chemotherapy Urged for Rare Type of Bladder Cancer

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Neoadjuvant chemotherapy for patients with small cell urothelial carcinoma (SCUC) improves their likelihood of survival compared with a historical cohort of patients treated with initial cystectomy, a study found.

Based on the study's findings, researchers concluded that neoadjuvant chemotherapy should be considered for all patients with surgically resectable SCUC.

Investigators at the M.D. Anderson Cancer Center in Houston led by Arlene Siefker-Radtke, MD, studied 95 SCUC patients who were surgical candidates. Of these, 48 received neoadjuvant chemotherapy and 47 underwent initial surgery. The median overall and disease-specific survival were significantly greater in the adjuvant chemotherapy recipients than those who had initial surgery (159.5 vs. 18.3 months and 79% vs. 20%, respectively), according to a report in European Urology (published online ahead of print).

Adjuvant chemotherapy had no impact on overall survival among patients treated with initial cystectomy, although the small number of patients limits the impact of this finding. The median overall survival for those treated and not treated with adjuvant chemotherapy was 18.1 vs. 18.3 months, respectively.

“Neoadjuvant chemotherapy for SCUC is associated with a high rate of pathologic downstaging and correlates significantly with higher survival as compare to historical expectations,” the authors wrote. “With initial surgery, there is an increased risk of pathologic upstaging, at times leading to an aborted cystectomy and resulting in poor outcomes.”

Neoadjuvant chemotherapy resulted in pathologic downstaging in 62% of tumors compared with only 9% for those who underwent initial surgery.
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