IBCN 2019: Non-Cisplatin Based Neoadjuvant Chemotherapy Agents for Cisplatin-Ineligible Patients Prior to Radical Cystectomy

Aarhus, Denmark (UroToday.com) Dr. Vikram Narayan from the University of Texas MD Anderson Cancer Center presented data on behalf of Dr. Justin Matulay and Dr. Neema Navai’s group summarizing a retrospective cohort study investigating the efficacy of non-cisplatin based neoadjuvant chemotherapy agents for cisplatin-ineligible patients prior to radical cystectomy.

Over 674 patients were included in the study with a median follow-up of 32.3 months, following a review of consecutive high-risk, clinically node-negative muscle-invasive bladder cancer (MIBC) patients undergoing radical cystectomy (RC) between 2005 and 2017 at the MD Anderson Cancer Center. Pre-operative high-risk criteria included one or more of the following: lymphovascular invasion, hydronephrosis, presence of extravesical disease, and/or variant histology. Primary outcomes were cancer-specific survival (CSS) and overall survival (OS). Cisplatin-based neoadjuvant chemotherapy (NAC) was used in 63% of patients, non-cisplatin NAC (defined as any regimen containing at least one cycle of cisplatin-therapy) was used in 11.6% of the cohort, while the remainder of patients (26%) proceeded to immediate radical cystectomy. Although patients who underwent chemotherapy had more high risk features than those who went straight to RC, administration of any NAC (either cisplatin-based or non-cisplatin based) was associated with a higher pathologic complete response rate (28.4% of cisNAC, 23.1% of non-cisNAC, and 7.5% of immediate RC).

Despite this, univariate OS and CSS improvements were only observed in patients receiving a cisplatin-containing regimen, and neither receipt of cisNAC nor non-cisNAC were independently predictive of survival outcomes. This finding may be secondary to unmeasured confounders but may also question the validity of continuing to use the pathologic complete response as a surrogate endpoint in clinical trials moving forward. Additionally, these data provide a benchmark for understanding outcomes of cisplatin-ineligible high-risk MIBC patients receiving alternative therapies.


Abstract take-home message:

  • Non-cisplatin neoadjuvant chemotherapy options for cisplatin-ineligible patients with an approximately 23% pathologic complete response rate at the time of radical cystectomy, although this did not correlate with improved survival outcomes.

Presented by: Vikram Narayan, Urologic Oncology Fellow, the University of Texas MD Anderson Cancer Center, Houston, Texas

Written by: Dr. Vikram M. Narayan (@VikramNarayan), Urologic Oncology Fellow with Ashish M. Kamat, MD (@UroDocAsh), Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 17th meeting of the International Bladder Cancer Network, (IBCN, #IBCN2019) October 3rd – 5th, 2019 in Aarhus, Denmark.