Renal function may decline slightly in the first year after trimodal therapy (TMT) for muscle-invasive bladder cancer (MIBC) but then remains stable long-term. In addition, development of upper tract urothelial carcinoma (UTUC) following TMT is relatively uncommon, with a rate comparable to that associated with radical cystectomy.
Those are the findings of separate studies by investigators at Massachusetts General Hospital in Boston and presented at the American Urological Association’s 2023 Annual Scientific Meeting in Chicago, Illinois.
TMT consists of transurethral resection of bladder tumor and radiation therapy combined with chemotherapy. It is an accepted alternative to radical cystectomy. Various chemotherapy agents used for TMT, such as mitomycin, 5-fluorouracil, and cisplatin, are nephrotoxic.
The studies are the first to inform clinicians of the potential effect of TMT and chemoradiation on future renal function, as well as the first to describe the subsequent occurrence of UTUC after TMT for MIBC, said the senior author of both studies, Adam S. Feldman, MD, MPH, Director of Urologic Research/Vice Chair in the Department of Urology at Massachusetts General Hospital and Assistant Professor of Surgery at Harvard Medical School in Boston. The findings from these studies will better inform clinicians and patients who are considering their options for treatment of MIBC, Dr Feldman said.
In a study of 287 patients who underwent TMT for MIBC and had a median follow-up of 4.6 years, a team led by Affan Zafar, MD, found that patients’ mean estimated glomerular filtration rate (eGFR; in mL/min/1.73 m2) declined slightly from 65.67 at baseline to 58.43 at 1 year. The eGFR values at 3, 5, and 10 years were 55.40, 54.54, and 57.30, respectively.
The other study, which was led by Jillian Egan, MD, included 271 patients who underwent TMT for MIBC and had a median follow-up of 51.8 months. UTUC developed in 7 patients (2.6%) following completion of TMT. The median time to recurrence was 46 months. Dr Egan’s team concluded that post-TMT UTUC is “relatively rare.”
“The management of UTUC after TMT can proceed according to UTUC standard of care with no increased risk of complications or poor outcomes,” the investigators wrote in a poster presentation.
“Our data on renal function demonstrate that while there may be a slight decline in renal function in the first year after TMT, renal function should not be further affected long term,” Dr Feldman said in an interview. “These effects on renal function are important to understand when considering options for the treatment of MIBC, including TMT vs radical cystectomy, which can also have long term effects on renal function. Our data also demonstrate that the risk of developing UTUC after TMT for MIBC is low at 2.6%, and is comparable to rates of UTUC after radical cystectomy for MIBC. Therefore, this should not be considered a significant factor in weighing options for management of MIBC.”
Zafar A, Nguyen L, Hunter A, et al. Long-term renal function in patients undergoing trimodal therapy for bladder cancer. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Poster MP56-14.
Egan J, Zafar A, Nguyen L, et al. Development and outcomes of upper tract urothelial carcinoma following trimodal therapy for muscle invasive bladder cancer. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Poster MP56-15.