Neoadjuvant Chemo vs TUR Before RC Ups Survival

SAN FRANCISCO—Patients with muscle-invasive bladder cancer (MIBC) who receive neoadjuvant chemotherapy (NAC) rather than undergo transurethral resection alone before radical cystectomy have better survival, researchers reported at the American Urological Association 2018 annual meeting.

Kris Miguel Cajipe, MD, of the University of Texas Health Science Center in San Antonio, and collaborators compared overall survival between radical cystectomy (RC) patients who achieved pathologic downstaging after NAC vs TUR without chemotherapy. Of 24,763 RC patients from identified using the National Cancer Data Base (2004 to 2014), 7.2% had downstaging to non-invasive disease (pT0/Tis/TaN0) and 4.1% had complete downstaging (pT0N0). Just 15.5% overall underwent NAC. Among patients downstaged to noninvasive disease, 42.5% had NAC and 57.5% had TUR before RC. Among those with complete downstaging, 45.8% had NAC and 54.2% had TUR. Results showed that patients with cT2 disease were significantly more likely to undergo TUR only, whereas patients with cT3 disease were more likely to receive NAC; cT4 patients exhibited no proclivity.

Significantly more NAC vs TUR-only patients achieved complete downstaging (10.8% vs 2.6%) or noninvasive disease (17.6% vs 4.8%). In addition, compared with TUR only, NAC was associated with a significant 38% and 48% decreased risk of death among patients with noninvasive and complete downstaging, respectively. After Cox regression hazard analysis, NAC emerged as an independent predictor of overall survival in both groups.

“Our analysis demonstrates that even though complete and non-invasive downstaging status can be achieved by transurethral resection of the bladder tumor, there is still a survival advantage in those who receive neoadjuvant chemotherapy,” Dr Cajipe told Renal & Urology News. “Despite this, we discovered that utilization of neoadjuvant chemotherapy remains low at 15%. The findings suggest the providers should offer neoadjuvant chemotherapy to more eligible patients with muscle-invasive bladder cancer.”

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Cajipe KM, Wang H, Chowdhury W, et al. Pathological downstaging at radical cystectomy for muscle-invasive bladder cancer: Survival outcomes in the setting of neoadjuvant chemotherapy versus transurethral resection only. Data presented in poster format at the American Urological Association 2018 annual meeting, San Francisco, May 18–21. Abstract MP78-01.