SUO 2017: Refining Selection Criteria for Neoadjuvant Chemotherapy - MIBC
The authors identified patients with MIBC who underwent RC with or without NAC at two institutions. Patients were considered high-risk based on the presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection. Whole-genome analysis was performed on transurethral resected specimens classifying them into basal, luminal or p53-like subtypes. Overall survival (OS) outcomes were compared for each subtype and clinical risk criteria. There were 165 patients that were included in the analysis, including 52 (32%) patients who were low-risk, 113 (68%) patients who were high-risk; 49 (30%) of patients had basal tumors. Furthermore, 99 (60%) patients received NAC and of these, 82 (83%) were high-risk and 17 (17%) were low-risk. A significant survival benefit with NAC was seen in patients with basal tumors in both high-risk and low-risk cohorts (p<0.0001). There was no statistically significant difference in benefit for NAC in patients with either luminal (p=0.23), or p53-like subtype tumors (p=0.41).
Dr. Duplisea concluded that neoadjuvant chemotherapy seems to benefit patients with basal tumors regardless of whether they fall into the high-risk or low-risk group, confirming initial studies suggesting a response benefit for patients with basal tumors. Once validated, the risk criteria to identify high-risk tumors may include basal tumors, specifically because OS is this subtype is prolonged after NAC.
References:
1. Seiler R, Ashab HAD, Erho N, et al. Impact of molecular subtypes in muscle-invasive bladder cancer on predicting response and survival after neoadjuvant chemotherapy. Eur Urol 2017;72(4):544-554.
Presented by: Jonathan Duplisea, MD Anderson Cancer Center, Houston, TX
Co-Authors: Michael Metcalfe MD², Debasish Sundi MD², Roger Li MD², James Ferguson MD PhD², Shanna Pretzsch PhD², Jolanta Bondaruk PhD², Bogdan Czerniak MD², Ashish Kamat MD², Neema Nevai MD², Jay Shah MD², Woonyoung Choi PhD², David McConkey PhD², Peter Black MD³ and Colin Dinney MD²
¹MD Anderson Cancer Center Houston, Texas; ²MD Anderson Cancer Center Houston Texas; ³University of British Columbia Department of Urologic Sciences Vancouver BC Canada
Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC