Neoadjuvant vs Adjuvant Chemo Ups MIBC Patient Survival
The 5-year overall survival rate is significantly higher among radical cystectomy patients who receive neoadjuvant vs adjuvant chemotherapy, study finds.
The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2018.
SAN FRANCISCO—Patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) experience improved survival if they receive neoadjuvant rather than adjuvant chemotherapy, investigators reported at the American Urological Association annual meeting.
Using the National Cancer Data Base, Joshua Jue, MD, and colleagues at the University of Miami School of Medicine identified 509 RC patients treated with neoadjuvant chemotherapy (NAC) and 283 treated with adjuvant chemotherapy (AC) from 2004 to 2013. Patients who received NAC were propensity score matched by age, race, ethnicity, sex, insurance type, academic/research program, comorbidity, and clinical stage to patients receiving AC within 90 days.
The NAC group had significantly better 5-year overall survival (OS) rates than the AC group (50.3% vs 38%). In addition, NAC was a significant predictor of decreased mortality, decreased progression to node positivity, and downstaging to non-muscle invasive bladder cancer (NMIBC). Compared with AC, NAC was associated with a 32% and 82% decreased risk of death and progression to node positivity and a nearly 13-fold increased likelihood of downstaging to NMIBC.
The investigators concluded that the increased survival associated with NAC compared with AC among RC patients may be due to decreased progression to node positivity and pathologic downstaging.
In a separate study presented at the conference, Dr Jue and colleagues demonstrated that earlier use of AC following RC is associated with improved OS. Patients who underwent RC and received no AC or AC more than 45 days following RC were propensity score matched to patients who received AC 45 days or less following RC. Patients who received AC 45 days or less following RC had significantly better 5-year OS than those who received AC more than 45 days following RC or no AC (47% vs 37.5% and 41.2%, respectively).
Jue J, Koru-Sengul T, Miao F, et al. Neoadjuvant vs adjuvant chemotherapy for muscle-invasive bladder cancer: A propensity matched analysis. Oral presentation at the American Urological Association 2018 annual meeting in San Francisco, May 18–21. PD15-09.
Jue J, Kroeger Z, Koru-Sengul T, et al. Timing of adjuvant chemotherapy and survival following radical cystectomy. Oral presentation at the American Urological Association 2018 annual meeting in San Francisco, May 18–21. PD15-06