MIBC: NACT tops ACT for disease-free survival

  • Del Bene G & al.
  • Front Oncol
  • 1 Jan 2018

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In men with muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy (NACT) was associated with superior DFS vs adjuvant chemotherapy (ACT), but not OS or cancer-specific survival (CSS).
  • After NACT, patients with complete pathologic response (pT0) vs residual disease (≥pT1) showed higher DFS and OS

Why this matters

  • Limited evidence comparing NACT and ACT is available.

Study design

  • Study of 656 patients with MIBC (>pT2) from RISC (Retrospective International Study of Cancers of the Urothelial Tract) database who underwent cystectomy during 2005-2012.
  • 325 patients were treated with ACT and 331 with NACT.
  • Funding: None disclosed.

Key results

  • In the NACT vs ACT group, 74.9% vs 71.1% of patients received cisplatin-based chemotherapy.
  • Median DFS was significantly longer in patients who received NACT vs ACT (34.6 vs 24.9 months; HR, 0.78; P=.02).
  • No difference was observed between NACT and ACT in
    • CSS (115.2 vs 92.8 months; HR, 1.06; P=.70) and
    • OS (51.7 vs 66.8 months; HR, 1.08; P=.57).
  • In the NACT group, patients with pT0 vs ≥pT1 disease showed higher
    • 5-year DFS: 62% vs 21% (P<.0001 and>
    • 5-year OS: 72% vs 31% (P<.0001>

Limitations

  • Retrospective design.

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