AUA 2017: Use of Adjuvant Chemotherapy In Patients With Advanced Bladder Cancer After Neoadjuvant Chemotherapy

Boston, MA ( Patients with non-organ confined disease at radical cystectomy (RC) have a poor prognosis, even after neoadjuvant chemotherapy (NAC). The authors hypothesized that use of adjuvant chemotherapy (AC) is associated with improved survival compared to observation in patients with advanced disease who were treated with NAC before RC.

Using the National Cancer Database, the authors identified patients who received NAC prior to RC and had advanced stage (pT3/4) or pathologically involved lymph nodes (pN+) at the time of surgery during 2004-2013. Multivariable proportional hazards regression analysis was used to estimate the impact of AC on overall survival.

Overall 705/2143 (33%) who received NAC before undergoing RC were pT3/4 and/or pN+ at time of cystectomy. Of these patients, 24% (N=168) received subsequent AC and the rest were observed (N=553). Median survival for the entire cohort was 21 months (IQR 12-45). Compared to the observation group, the AC group had longer median survival however this was not statistically significant (23 months [IQR 14-46] versus 20 months [IQR 12-46], log-rank p = 0.52). On multivariate analysis there was no survival advantage for the AC cohort. Subgroup analysis of pN+ patients who received AC also did not show a survival advantage.

In summary, patients who are pT3/4 and/or pN+ after NAC and RC have overall poor prognosis. The addition of AC does not seem to be significantly change their dire prognosis.

Presented By: Wilson Sui, New York, NY

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
Twitter: @Goldberghanan

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA