CUA 2018: Trends and Disparities in the Use of Neoadjuvant Chemotherapy for Muscle-Invasive Urothelial Carcinoma

Halifax, Nova Scotia (UroToday.com) Neoadjuvant chemotherapy (NAC) prior to radical cystectomy is considered the standard of care for patients with muscle-invasive urothelial carcinoma (MIBC). However, widespread adoption of this standard of care has historically been low, although in recent years there is an increase in the use of NAC. The authors of this study examined whether the use of NAC has continued to increase with time and what factors are associated with the receipt of NAC.

All patients included in the National Cancer Database who underwent radical (RC) or partial cystectomy  (PC) for cT2-CT4N0M0 urothelial carcinoma from 2006-2014 were analyzed. Logistic regression models were used to evaluate clinical and socioeconomic factors associated with the receipt of NAC.

A total of 18,188 patients were identified who underwent RC or PC for MIBC. Overall, 3940 (21.7%) received NAC. There was a significant increase in the use of NAC over time, from 9.7% in 2006 to 32.2% in 2014 (Figure 1). Logistic regression analysis demonstrated that factors associated with lower use of NAC included older age, increased number of comorbidities, lower cT stage, lower hospital RC volume, treatment at a non-academic center, lower patient income, and receipt of partial cystectomy (all p<0.01) (Table 1). Interestingly, patient sex and race were not associated with the receipt of NAC.

Table 1 – Factors associated with utilization of neoadjuvant chemotherapy:

UroToday CUA 2018 Trends and Disparities in the Use of Neoadjuvant Chemotherapy for Muscle Invasive Urothelial Carcinoma
The authors concluded that use of NAC for patients with MIBC has increased significantly over time to a modest rate of 32%. However, there are still significant disparities that exist in the receipt of NAC. Improved risk stratification to identify high-risk individuals is required to increase the use of NAC.
UroToday CUA 2018 Trends and Disparities in the Use of Neoadjuvant Chemotherapy for Muscle Invasive Urothelial Carcinoma 2


Presented by:  Jonathan Duplisea, MD Anderson Cancer Center — Houston, United States

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia
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