SIU 2017: Patterns of Neoadjuvant Chemotherapy Use and its impact on Optimal Timing to Radical Cystectomy for Patients with Muscle invasive Bladder Cancer

Lisbon, Portugal (   Neoadjuvant chemotherapy with radical cystectomy is now the standard of care for muscle-invasive bladder cancer (MIBC). The authors aimed to discern the impact of delayed timing associated with the use of neoadjuvant therapy to the survival benefit of radical cystectomy.

In this study patients with stage II-IV bladder cancer between January 1, 2001 and December 31, 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER) Medicare linked data. The data was stratified based on neoadjuvant chemotherapy use. Temporal trends in neoadjuvant chemotherapy and delayed radical cystectomy were assessed using the Cochran-Armitage test. Logistic regression models and generalized linear models were performed to determine the association between patient and clinical factors and the use of neoadjuvant chemotherapy, as well as delayed radical cystectomy. Cox proportional hazards models were used to compare overall survival controlling for patients demographics and clinical characteristics.

Overall the results demonstrated that a total of 2,738 patients met the study criteria, of whom 344 (12.6%) received neoadjuvant chemotherapy. The use of neoadjuvant chemotherapy more than tripled during the study period, from 5.7% in 2001 to 17.3% in 2011 (p < 0.0001). The observed rate of delayed radical cystectomy averaged approximately 44% over the study period. The use of neoadjuvant chemotherapy was associated with delayed radical cystectomy with a relative risk (RR 1.21, 95% CI 1.08 to 1.35; p < 0.001). Among patients who underwent delayed radical cystectomy, neoadjuvant chemotherapy was not associated with survival benefits.

The authors therefore concluded, that use of neoadjuvant chemotherapy can significantly delay the time to radical cystectomy and offered no superior overall survival compared to patients who underwent delayed radical cystectomy without neoadjuvant chemotherapy. Surgery eligible bladder cancer patients should undergo radical cystectomy promptly after neoadjuvant chemotherapy.

Presented by: Kosarek C.
Affiliation: The University of Texas Medical Branch, Galveston, United States; The University of Texas MD Anderson Cancer Center, Houston, United States; Cedars Sinai Medical Center, 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