AUA 2017: Neoadjuvant Chemotherapy for Elderly Patients with Locally Advanced or Early Nodal Disease: Are We Doing Enough?

Boston, MA ( Dr. Correa and colleagues from the Fox Chase Cancer Center presented their data assessing neoadjuvant chemotherapy (NAC) for elderly patients with locally advanced bladder cancer at this afternoon’s invasive bladder podium session at the 2017 AUA Annual meeting. Given the level 1 evidence we have supporting NAC for muscle invasive bladder cancer (MIBC), whether this can be extended to patients with locally advanced or node positive disease is somewhat speculative. The authors aim for this study was to assess the NAC administration trends in patients with locally advanced and low stage nodal disease using population level data.

Using the National Cancer Data Base (NCDB) from 2004-2014, 19,299 patients with clinical T2-T4 and low nodal disease burden (N0-N2) were identified. NAC utilization increased over the study period with 35.6% of patients receiving NAC in 2014 compared to 10.1% in 2004.

Interestingly, decreasing NAC utilization was associated with increasing age (< 65 years: 28.0%;65-74 years: 23.9%; ≥75 years: 12.3%, p<0.001). On multivariable analysis, increasing clinical stage and early nodal disease was found to be associated with an increase in the administration of NAC: the likelihood of NAC administration of T3N0 and T4N0 and Tany/N1-2 was 1.31 (95%CI 1.14-1.50) and 1.63 (95% CI 1.43-1.87), respectively compared to cT2N0. Similarly, increasing age was associated with a decrease in the use of NAC: the likelihood of NAC administration for patients 65-74 years and ≥75 years was 0.89 (95%CI 0.82-0.91) and 0.39 (95% CI 0.34-0.44), respectively compared to patients <65 years of age. The strength of this study is the high-quality population-level analysis allowing for clinically meaningful results.

In conclusion, although the administration of NAC has increased over the last 10 years, the use of NAC in the elderly remains low even among those present with advanced and low burden nodal disease. Further studies assessing what factors are precluding these patients from receipt of NAC are needed.

Speaker: Andres Correa, Fox Chase Cancer Center, Philadelphia, PA, USA

Co-Authors: Elizabeth Handorf, Benjamin Ristau, Haifler Haifler, Shreyas Joshi, Robert Uzzo, Rosalia Viterbo, Richard Greenberg, David Chen, Alexander Kutikov, Daniel Geynisman, Marc Smaldone

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre
Twitter: @zklaassen_md

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