PD18: Bladder Cancer: Upper Tract Transitional Cell Carcinoma I
PD18-01: RADIOGRAPHIC PREDICTORS OF PATHOLOGIC RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH HIGH-GRADE UPPER TRACT UROTHELIAL CARCINOMA: RESULTS OF A PHASE 2 CLINICAL TRIAL
Friday, May 15, 2020
7:00 AM – 9:00 AM
Nathan C. Wong, Daniel Sjoberg, Soleen Ghafoor, H. Alberto Vargas, Nicholas Silva, Bernard H. Bochner, Guido Dalbagni, S. Machele Donat, Harry W. Herr, Eugene Cha, Timothy Donahue, Eugene Pietzak, Hikmat Al-Ahmadie, Nicole Benfante, Gopa Iyer, Min Yuen Teo, Jonathan E. Rosenberg, Dean F. Bajorin, Jonathan A. Coleman
Introduction: Neoadjuvant chemotherapy (NAC) has established survival benefits prior to cystectomy for bladder cancer, yet its role in upper tract urothelial carcinoma (UTUC) prior to nephroureterectomy (NU) is less clear. We performed a phase 2 clinical trial of NAC in patients with UTUC to evaluate pathologic response. Herein, we investigated whether radiographic responses could predict pathologic response and oncologic outcomes.
Methods: Patients with high-risk localized UTUC (high grade disease on biopsy and/or radiographic cT2-4 disease with positive select cytology) received 4 cycles of gemcitabine and cisplatin prior to NU with the primary objective of the phase 2 study being pathologic response, defined as =pT1N0. Patients underwent CT imaging at baseline and after chemotherapy and were reviewed by a dedicated GU radiologist. All baseline imaging studies were categorized as: (i) no abnormality, (ii) focal mass or (iii) urothelial thickening without mass. Post-chemotherapy imaging studies were categorized as: (i) radiographic stable disease (rSD), (ii) progression of disease, (iii) partial response (rPR) or (iv) complete response (rCR). Radiographic responses were correlated with final pathologic staging and progression-free survival.
Results: A total of 54 patients (pT0 = 11, =pT1 = 26 and >pT1 = 17) had CT scans perform pre- and post-chemotherapy. All patients had a visible lesion seen on imaging, either mass (N = 38) or urothelial thickening (16). Median pre-chemotherapy mass size was 3.1cm (IQR 1.8, 3.9) and 55.5% of patients had hydronephrosis. Following chemotherapy, 14 patients had rCR, 25 had rPR and 15 had rSD. No patients progressed radiographically. Of patients with rCR, 85% had a pathologic response compared to rPR (72%) and rSD (33%) (p-value = 0.009). As shown in Figure 1, patients with a rCR and a rPR had a non-statistically higher 2-year progression-free survival compared to those with rSD (82% and 78% respectively vs 56%, p = 0.2).
Conclusions: Radiographic response following NAC for UTUC appears to correlate with pathologic response and progression-free survival. Radiographic response, in addition to other pre-operative predictors, may play a useful role in counseling and optimizing management of patients with UTUC. Source of
Funding: This research was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers and funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.