Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) for muscle-invasive bladder cancer in “real world” patients offers no clear survival advantage in all comers, a finding that contrasts with results from randomized controlled trials, investigators concluded in a study presented at the 2017 Genitourinary Cancers Symposium in Orlando, Florida.
Nawar Hanna, MD, of Brigham and Women’s Hospital in Boston, and colleagues compared the effectiveness of NAC plus RC compared with RC alone in a study of 8732 patients who underwent RC for muscle-invasive urothelial carcinoma identified using the National Cancer Data Base, which includes information on patients in the general population. Of these, 1619 patients received NAC plus RC and 7113 received RC alone. At 5 years of follow-up, the investigators observed no statistically significant difference in overall survival rates between the groups (51.4% vs 48.8%) after adjusting for immortal-time bias and pre-operative characteristics. By comparison, at 5 years, the OS rates for NAC plus RC and RC alone in the SWOG-8710 randomized clinical trial were 57% and 43%, respectively, a borderline statistically significant difference (p=0.06 by a stratified log-rank test).
“To our knowledge, this is the first study looking at the effectiveness of neoadjuvant chemotherapy before radical cystectomy in the general patient population,” Dr Hanna told Renal & Urology News. “Interestingly, we did not find an overall survival benefit associated with the receipt of neoadjuvant chemotherapy in all patients, although we acknowledge the limitations of population-based studies. In our opinion, a subset of patients do benefit significantly from neoadjuvant chemotherapy, and increasing efforts are ongoing in identifying these patients.”
Patients with locally advanced disease or with tumors having a genetic susceptibility to platinum-based regimens might benefit the most from NAC before RC, Dr Hanna said.
1. Hanna N, Trinh QD, Sammon J, et al. Is neoadjuvant chemotherapy beneficial before radical cystectomy in the “real world” setting? An external validation study within the U.S. Presented in poster format at the 2017 Genitourinary Cancers Symposium in Orlando, Florida. Poster Session B, Board F20. Abstract 331.