Buenos Aires, Argentina (UroToday.com) Ashish Kamat, Professor MD Anderson Cancer Center, and Arnulf Stenzl, University of Tubinen Medical School discussed utility of neoadjuvant chemotherapy (NAC) in MIBC.
NAC is significantly underutilized despite level one evidence showing improved survival owing to concerns regarding toxicity and inadequate evidence from all RCTs (metanalysis showing only 5% and 9% improvement in overall and disease-specific survival, respectively). Such small differences while significant may not be significantly large enough to cause clinical change in management. Subtyping MIBC is another determinant for who NAC may be more appropriate, however, to date there is no trial which has assessed the utility of subtypes according to NAC versus no NAC. At our institution, we select patients for NAC including prior predictors for improved survival with NAC (clinical stage, LVI, cis and hydronephrosis, variant histology). Those without any of these adverse features undergo upfront radical cystectomy with remainder to undergo NAC followed by radical cystectomy and extended bilateral pelvic lymph node dissection. Regarding variant histology, we have previously determined risk stratification for patients with micropapillary variant histology where radical cystectomy is recommended for NAC for cTany with hydronephrosis and upfront radical cystectomy for the remaining including cT1 patients.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.