ASCO GU 2018: Effectiveness of Transurethral Resection Plus Systemic Chemotherapy as Definitive Treatment for Muscle-Invasive Bladder Cancer

San Francisco, CA ( Transurethral resection of bladder tumor (TURBT) + neoadjuvant cisplatin-based chemotherapy achieves a pathologic complete response in 30-40% of patients with muscle invasive bladder cancer (MIBC). Prior studies have demonstrated that long-term survival is possible for a subset of patients with MIBC treated with TURBT plus chemotherapy alone, but such analyses have been limited by small sample sizes and poor generalizability. In this study, the authors aimed to describe the characteristics and outcomes of patients managed with this approach using a large national registry.

Within the National Cancer Database (2004-2015), the authors identified 1,538 patients who were treated with TUR + multi-agent systemic chemotherapy, without radiation, as definitive treatment for cT2-T4aN0M0 urothelial carcinoma of the bladder. Baseline characteristics were compared relative to those of 17,866 patients treated during the same period of time with radical cystectomy ± perioperative chemotherapy. Treatment outcomes were assessed using Kaplan-Meier analysis.

Compared to patients who were treated with cystectomy ± perioperative chemotherapy, patients treated with TURBT + chemotherapy alone were significantly older (≥75 years old 33.9% vs. 29.6%; p < 0.0001), had a higher clinical T stage (cT3-T4: 23.5% vs. 18.1%, p < 0.0001) and were more frequently treated in non-academic facilities (64.7% vs. 48.1%; p < 0.001). There were no significant differences between groups regarding gender, Charlson comorbidity score, and income/education level. The 30-day and 90-day mortality with TUR + chemotherapy was 0.16% and 3.76%, respectively. The 5-year survival rate for T3-T4 treated with TUR + chemotherapy was 23.3% (95% CI 18.6, 29.2), and limited to patients with cT2 disease was 36.21% (95% CI 32.9, 39.9).

This large real-world cohort representing the continuum of practice settings in the United States confirms that long-term survival is achievable in a subset of patients treated with TUR + chemotherapy alone for MIBC. Refinement of this bladder-sparing approach integrating putative predictive biomarkers of pathologic complete response is now the focus of recently initiated prospective clinical trials.

Presented by: François Audenet, Mount Sinai, New-York, USA 

Co Authors: Nikhil Waingankar, Bart Ferket, Scot Anthony Niglio, Kathryn E. Marqueen, Reza Mehrazin, John Sfakianos, Matt D. Galsky; Icahn School of Medicine at Mount Sinai, New York, NY, France; Icahn School of Medicine at Mount Sinai, New York, NY; Icahn School of Medicine at Mount Sinai Tisch Cancer Institute, New York, NY

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA