Login to Access Video or Poster Abstract: MP10-16
Sources of Funding: None

Introduction

Neoadjuvant chemotherapy (NC) with a cisplatin-containing regimen followed by radical cystectomy (RC) is the gold-standard treatment for muscle invasive bladder cancer (BC), supported by level 1 evidence. However, the proportion of patients receiving NC prior to RC remains low. Herein, we analyze our experience in a contemporary cohort of 145 consecutive patients treated with RC over a two-year period with an emphasis on receipt of NC.

Methods

We retrospectively reviewed 145 consecutive patients who underwent RC at our institution between 2012 and 2013. Demographic data, eligibility for and completion of NC, as well as reasons for forgoing NC were determined. Additionally, the time between BC diagnosis at TUR-BT and RC was calculated to determine the eligibility period for future experimental therapies.

Results

32/145 (22.1%) patients underwent NC prior to RC. Of the 113 patients undergoing RC without NC, 46 (40.7%) had non-muscle invasive disease and were therefore not candidates for NC. The remaining 67 (59.3%) patients had indications for but did not complete NC. The most common reasons for forgoing NC were patient refusal due to toxicities and perceived modest benefit (31/113 patients, 27.4%), and variant histology resulting in primary RC (15/113, patients 13.3%). 9/113 patients (8%) were ineligible for NC due to poor renal function and 3/113 patients (2.7%) due to advanced age and/or poor functional status. The remainder of patients (9/113 patients, 8.0%) were excluded due to perioperative factors mandating primary RC or disease restricted to the prostatic urethra. We observed a median time from TURBT to RC of 34 days in patients not receiving NC.

Conclusions

Our data demonstrate that a large proportion of patients undergoing RC in the contemporary era are either ineligible for or refuse neoadjuvant chemotherapy. These data highlight the need for novel neoadjuvant therapies for invasive disease with improved toxicity/efficacy profiles. Additionally, we have defined a patient population with non-muscle invasive disease undergoing RC who would be eligible for future clinical trials utilizing the neoadjuvant setting to evaluate experimental bladder-sparing regimens.

Funding

None