Bladder cancer: neoadjuvant chemotherapy improves response in patients without preoperative hydronephrosis

  • Soria F & al.
  • BJU Int
  • 5 Nov 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with cT2N0 bladder cancer and no preoperative hydronephrosis undergoing radical cystectomy, neoadjuvant chemotherapy (NAC) improves the rate of pathologic complete response and downstaging.

Why this matters

  • NAC is underused in stage T2 disease.
  • Study findings reinforce the current recommendations regarding NAC in cT2-T4a muscle invasive bladder cancer.

Study design

  • 619 patients with cT2N0 bladder cancer with no preoperative hydronephrosis underwent radical cystectomy with or without neoadjuvant chemotherapy.
  • Funding: None disclosed.

Key results

  • In patients who received NAC vs those who underwent upfront surgery:
    • Complete response rate was 30% vs 3%.
    • Objective response rate was 55% vs 24%.
  • NAC was an independent predictor of:
    • Objective response rate (OR, 2.82; P=.004).
    • Complete response (OR, 4.91; P=.001).
  • No significant difference in OS was observed between groups (OR, 0.78; P=.3) with a median follow-up of 18 months.

Limitations

  • Retrospective.
  • Short follow-up and low number of events.