SIU 2017: Association between Pre-Cystectomy Epithelial Tumor Marker Response to Neoadjuvant Chemotherapy and Oncological Outcomes in Urothelial Bladder Cancer

Lisbon, Portugal (  The authors previously reported that elevated pre-cystectomy serum levels of epithelial tumor markers predict worse oncological outcome in patients with invasive bladder cancer (BC). In this study, the authors evaluated the effect of neoadjuvant chemotherapy (NAC) on elevated tumor marker levels and their association with oncological outcomes.

Serum levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 480 patients with invasive BC from August 2011 through December 2016. In the subgroup undergoing NAC, markers were measured prior to the first and after the last cycle of chemotherapy (prior to cystectomy).

Overall three hundred and thirty seven patients were eligible for the study, with a median age of 71 years (range 34-93) and 81% (272) being male. Elevated pre-cystectomy level of any tumor markers (31% of patients) was independently associated with Worse recurrence free survival (RFS) (HR=2.81; p<0.001) and overall survival (OS) (HR=3.97, p<0.001). 125 (37%) patients underwent NAC, of whom 59 had a complete tumor marker profile before and after therapy and 30 (51%) had one or more elevated pre-NAC tumor markers. Following completion of chemotherapy, 10/30 (33%) patients normalized their tumor markers, while 20/30 (67%) had one or more persistently elevated markers. There was no difference in clinical or pathological stage between groups (p=0.54 and p=0.09, respectively). Further analysis showed a significantly lower rate and longer median time to recurrence/progression in the responder group (50% in responders vs 90% in non-responders at a median time of 22 vs 4.8 months respectively; p=0.015). There was also significant difference in mortality rates and median overall survival between the study groups (30% in responders vs 70% in non-responders at a median time of 27.3 vs 11.6 months respectively; p=0.037). Two of the three patients that died in the normalized tumor marker group had tumor marker relapse at recurrence prior to their death.

The authors conclude that this is the first study showing tumor marker response to NAC. Patients with persistently elevated markers following NAC have a very poor prognosis following cystectomy, which may help in identifying chemotherapy-resistant tumors. These potential biomarkers should be assessed in a larger controlled study.

Presented by: Bazargani ST
Affiliation: Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, United States

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal