Neoadjuvant vs. Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database.

Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36 to 48% for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy (AC) in MIBC. Methods: Data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival (OS), cancer specific survival (CSS), and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier method were compared for MIBC by log-rank test. All patients in this analysis received either NC or AC. Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median DFS was 34.6 months (95% CI:25.3-43.9) for NC vs. 24.9 months (95% CI: 19.4-30.5) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.78, 95% CI: 0.63-0.96, P = 0.02). There were no significant differences in terms of CSS (HR: 1.06, 95% CI: 0.79-1.43, P: 0.70), and OS (HR: 1.08, 95% CI: 0.83-1.39, P = 0.57). Conclusions: This study demonstrates superiority in DFS for NC compared to AC. The positive prognostic impact of complete pathological response to NC was confirmed.

Frontiers in oncology. 2018 Nov 19*** epublish ***

Gabriella Del Bene, Fabio Calabrò, Diana Giannarelli, Elizabeth R Plimack, Lauren C Harshman, Evan Y Yu, Simon J Crabb, Sumanta Kumar Pal, Ajjai S Alva, Thomas Powles, Ugo De Giorgi, Neeraj Agarwal, Aristotelis Bamias, Sylvain Ladoire, Andrea Necchi, Ulka N Vaishampayan, Günter Niegisch, Joaquim Bellmunt, Jack Baniel, Matthew D Galsky, Cora N Sternberg

San Camillo-Forlanini Hospital, Rome, Italy., IRCCS-Regina Elena Cancer Institute, Rome, Italy., Fox Chase Cancer Center, Philadelphia, PA, United States., Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States., Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, United States., University of Southampton, Southampton, United Kingdom., City of Hope Comprehensive Cancer Center, Duarte, CA, United States., University of Michigan, Ann Arbor, MI, United States., St. Bartholomew's Hospital, London, United Kingdom., Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRCCS, Meldola, Italy., Huntsman Cancer Institute at the University of Utah, Salt Lake, UT, United States., National & Kapodistrian University of Athens, Athens, Greece., Georges François Leclerc Cancer Center, Dijon1, France., Istituto Nazionale Tumori of Milan, Milan, Italy., Karmanos Cancer Institute, Detroit, MI, United States., Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany., Rabin Medical Center, Petah Tikva, Israel., The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.