Neoadjuvant chemotherapy appears effective in some patients with muscle-invasive bladder cancer (MIBC) of variant histology, a new study finds.
Of 31,218 patients with nonmetastatic MIBC in the 2004-2017 National Cancer Database who underwent radical cystectomy, 27,779 had pure urothelial carcinoma (UC), 501 had sarcomatoid UC, 418 had micropapillary UC, 1141 had squamous cell carcinoma, 629 had neuroendocrine carcinoma, and 750 had adenocarcinoma.
Receipt of neoadjuvant chemotherapy was associated with pathological downstaging to pT0N0 in all histological subgroups, Nicholas H Chakiryan, MD, of H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues reported in The Journal of Urology. In descending order, the odds of pathologic downstaging significantly increased 23.3-, 13.8-, 9.7-, 7.4-, 5.1-, and 4.7-fold for treated vs untreated patients with adenocarcinoma, sarcomatoid UC, micropapillary UC, squamous cell carcinoma, pure UC, and neuroendocrine tumors, respectively. For squamous cell carcinoma, the absolute rate of downstaging associated with neoadjuvant chemotherapy did not appear clinically relevant.
Neoadjuvant chemotherapy for pure UC was significantly associated with a 20% decreased risk for death. Neoadjuvant chemotherapy was significantly associated with 36% and 45% improved overall survival among patients with sarcomatoid UC and neuroendocrine carcinoma, respectively. The investigators noted that patients with adenocarcinoma tend to have favorable survival even without neoadjuvant chemotherapy.
“Overall, these data support the notion that neoadjuvant chemotherapy may be appropriate for some patients with variant histology MIBC, and management strategies should be tailored to the individual patient’s clinical and pathological characteristics,” Dr Chakiryan’s team concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Chakiryan NH, Jiang DD, Gillis KA, et al. Pathological downstaging and survival outcomes associated with neoadjuvant chemotherapy for variant histology muscle invasive bladder cancer. J Urol. 2021 Oct;206(4):924-932. doi:10.1097/JU.0000000000001855