Presentation Authors: Bashir Al Hussein Al Awamlh, Aleem Khan*, Benjamin Taylor, Lina Posada Calderon, Jonathan Fainberg, Talia Stark, Joe Nicolas, Douglas Scherr, New York, NY
Introduction: Pathologic complete response after neoadjuvant chemotherapy (NAC) is associated with better overall (OS) and recurrence free survival (RFS). Whereas, delay in cystectomy has been reported to be associated with worse outcomes. We sought to better understand the consequences of administering NAC to those who did not benefit from it by comparing oncological outcomes to patients who were eligible for NAC but underwent immediate cystectomy.
Methods: Retrospective review of 322 patients with with muscle-invasive bladder cancer who underwent radical cystectomy between 2001-2017. Non-responders (NR) to NAC on final pathology constituted the group of interest. Patients who underwent immediate cystectomy (IC) but were NAC eligible constituted the comparison group. Only those with â‰¥ pT2 were included in the analysis. Recurrence rates and patterns were compared between both groups. RFS, cancer-specific survival (CSS) and OS were estimated using the Kaplan-Meier method.
Results: A total of 132 (41%) received NAC, of which 68 (51.5%) had no pathologic response. Whereas, 154 patients (â‰¥ pT2) did not receive NAC and underwent IC. Patients in the NR group were younger (67 vs 75 years, p < 0.00001) compared to those who had IC, however baseline GFR was similar between groups (62 for both, p = 0.52). Pathologic tumor staging, nodal involvement, surgical margin status and lymphovascular invasion rates were similar in both groups (p >0.05, see table). _x000D_
Median follow up for surviving patients was 32.5 months. At last follow up, recurrence was higher in NR patients (59%) than IC (42%, p = 0.02), however both had similar distribution of disease recurrence as seen in the table. Non-responders had worse RFS (56% and 33% vs. 62% and 55%, p= 0.03) at 1 and 2 years but similar CSS (79% and 55% vs. 81% and 56%, p=0.75) and OS (68% and 36% vs. 68% and 38%, p= 0.5) compared to those in the IC group at 1 and 3 years.
Conclusions: Patients with â‰¥ pT2 who failed NAC had higher recurrence rates than those who had forgone NAC for immediate cystectomy. Our study demonstrates the opportunity for developing reliable biomarkers to predict benefit from NAC or improve surveillance protocols for those receiving NAC in order to minimize delay to cystectomy.
Source of Funding: Supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust