Bladder cancer: neoadjuvant chemotherapy improves outcomes

  • Zennami K & al.
  • BJU Int
  • 7 Sep 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 2 cycles of neoadjuvant chemotherapy (NAC) followed by surgery improved survival in patients with high‐risk cN0M0 upper tract urothelial carcinoma (UTUC), including those with localized disease (cT2 or lower).

Why this matters

  • This is the first report of NAC benefit in node-negative bladder cancer.
  • Further prospective research of short-course NAC in this setting is warranted to confirm the findings.

Study design

  • Study of 117 patients with high-risk cN0M0 UTUC who received NAC followed by surgery and 67 matched patients who underwent upfront surgery.
  • Funding: None disclosed.

Key results

  • The median follow-up was 51 months with NAC and 32 months with upfront surgery.
  • NAC vs upfront surgery group showed significantly:
    • Higher pathological downstaging (pDS): 47.9% vs 22.4% (P=.006).
    • Lower lymphovascular invasion (LVI): 29.9% vs 46.3% (P=.045).
  • At 5 years, NAC vs upfront surgery group showed significantly higher:
    • OS: 79% vs 53% (P=.003).
    • Cancer-specific survival: 84% vs 66% (P=.008).
    • Recurrence-free survival: 80% vs 61% (P=.001).
  • Patients with localized disease experienced significant OS benefit with NAC vs upfront surgery: 81% vs 56% (P=.019).
  • Significant predictors (HRs) of OS:
    • LVI: 4.782 (P=.002).
    • NAC: 0.495 (P=.038).
    • pDS: 0.280 (P=.035).

Limitations

  • Retrospective.