ASCO-GU 2019—Adjuvant chemotherapy + postop radiotherapy improves DFS, OS in locally advanced urothelial carcinoma


  • Univadis
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Takeaway

  • Adding adjuvant chemotherapy to postoperative radiotherapy (PORT) improved DFS and OS in patients with locally advanced bladder cancer (LABC) with urothelial histology who had undergone radical cystectomy (RC).

Why this matters

  • Suggests role for adjuvant therapies to address local and distant disease in LABC.

 Study design

  • Post-hoc analysis of urothelial carcinoma cohort in phase 3 trial that randomly assigned 153 patients with LABC who had undergone RC plus pelvic node dissection to chemo+PORT (2 cycles gemcitabine/cisplatin before and after PORT), or PORT (45 Gy in 1.5 Gy fractions twice/day).
  • Primary endpoint: DFS.

Key results

  • 81 patients in urothelial carcinoma cohort.
    • Chemo+PORT: 41 patients.
    • PORT: 40 patients.
  • Median follow-up.
    • Chemo+PORT: 21 months.
    • PORT: 15 months.
  • 2-year DFS.
    • Chemo+PORT: 62%.
    • PORT: 48%.
    • Log-rank P=.03.
  • 2-year OS.
    • Chemo+PORT: 71%. 
    • PORT: 51%.
    • Log-rank P=.048.
  • Adjuvant radiotherapy, which significantly improves local control, hypothesized to have synergistic effect with chemo.
    • May explain why larger adjuvant chemo trials, which did not include local adjuvant therapy, have failed to show benefits observed here.

Limitations

  • Post-hoc analysis.
  • Small cohort.
  • Standard instead of extended lymph node dissection.
  • Imbalance between trial arms in number of lymph nodes removed.

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