The Significance of Persistent Muscle Invasive After Neoadjuvant Chemotherapy - Expert Commentary

Downstaging of muscle-invasive bladder cancer (MIBC) following neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) has been correlated with higher survival rates.  

A new study published by Lane et al. in BJU International compared survival rates in patients with persistent MIBC NAC and RC compared to similarly staged patients who underwent RC alone. The investigators 1886 patients with non-metastatic persistent pT2-4 MIBC were identified from the Surveillance, Epidemiology, and End Results (SEER)- Medicare database from 2004-2011. 381 patients were treated with NAC +RC and 1505 who had undergone RC only. The authors adjusted for confounders, including age, sex, race, year of diagnosis, income, education, tumor stage, tumor grade, Charlson Comorbidity Index score, lymphadenectomy, and post-RC chemotherapy. The authors found that the overall survival rate among patients with persistent MIBC (pT2) was higher in those who received NAC + RC than those compared to those who had only had RC. On the other hand, they found no significant differences in cancer-specific survival between the two groups.  

The authors conclude that patients who have persistent muscle-invasive bladder cancer after platinum-based NAC+RC vs. RC alone derive an overall survival benefit but not a cancer-specific survival benefit from NAC.  It is important to interpret this result in light of the several limitations of this study. Current research efforts are underway to prospectively identify patients who can benefit from a bladder-sparing approach after achieving a complete response that incorporates molecular biomarkers of response to NAC. 

Written By: Bishoy M. Faltas, MD, assistant professor of medicine at Weill Cornell Medicine at New York Presbyterian hospital. 

Read the Abstract

Lane G, Risk M, Fan Y, Krishna S, Konety B. BJU Int. 2018 Aug 20. doi: 10.1111/bju.14529.