ASCO GU 2018: The impact of neoadjuvant chemotherapy on conditional survival among patients with muscle-invasive bladder cancer

San Francisco, CA (UroToday.com) Dr. Nikhil Waingankar and colleagues presented their results of neoadjuvant chemotherapy on conditional survival for patients with muscle-invasive bladder cancer (MIBC) at this afternoon’s poster session at GU ASCO. Achieving a pathologic complete response with neoadjuvant chemotherapy for MIBC is associated with a favorable prognosis (55% risk reduction for death [1]), however patients with pathologic residual disease generally have poor outcomes. Whether the difference in prognosis of patients with pathologic complete response and residual disease is sustained over time has not been explored and forms the objective of the current study.

For this study, the authors utilized the National Cancer Database for patients who received neoadjuvant chemotherapy and radical cystectomy for clinically localized MIBC (cT2-T4aN0M0) between 2002-2010 (n=1,554). Subsequently, patients with pathologic complete response (15 RC/year: 61% vs. 49%). Furthermore, patients with pathologic complete response had improved conditional survival relative to those with pathologic residual disease with survivorship up to 3 years, however the conditional survival benefit associated with pathologic complete response is attenuated from 4 years post-RC (96% vs 87%).

The authors concluded that MIBC patients with pathologic residual disease after neoadjuvant chemotherapy have worse conditional survival up to years 3 post-radical cystectomy, but this effect diminishes after 4 years of survival. These findings may inform patient counseling, surveillance intensity, and novel adjuvant approaches for patients with pathologic residual disease.

Speaker: Nikhil Waingankar, Icahn School of Medicine at Mount Sinai, New York, NY

Co-Authors: Rachel Jia, Bart Ferket, François Audenet, Reza Mehrazin, John Sfakianos, Madhu Mazumdar, Matt D. Galsky

Written by: Zachary Klaassen, MD, Clinical Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

References:
1. Petrelli F, Coinu A, Cabiddu M, et al. Correlation of pathologic complete response with survival after neoadjuvant chemotherapy in bladder cancer treated with cystectomy: A meta-analysis. Eur Urol. 2014;65(2)350-357.

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