Clinical outcomes following neoadjuvant cisplatin-based chemotherapy for bladder cancer in elderly compared with younger patients

Abstract

Bladder cancer is a disease of the elderly. Older patients might potentially be undertreated due to assumptions about benefit versus risk. Our objective was to determine outcomes in older patients receiving neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). We hypothesised that appropriately selected elderly patients (≥70 years) with MIBC could have similar clinical outcomes, and be safely treated, with standard neoadjuvant chemotherapy prior to definitive cystectomy or radiotherapy. We utilised a single institution case series analysis of patients with T2-4a N0 M0 transitional cell carcinoma of the bladder treated with cisplatin-based neoadjuvant chemotherapy between 2005 and 2011. Eighty-three patients were eligible. Median age was 68 (range 48-80), 33 patients (40%) were ≥70 years. Overall survival at 3 years was 65.8% (≥70) and 63.2% (<70) (P = 0.653), relapse-free survival at 3 years was 61.6% and 54.8% respectively (P = 0.471). The rates going forward to definitive local therapy (87.9% ≥ 70 and 84.0% < 70) and the pathological complete response rate (31.3% ≥ 70 and 40% < 70) were similar. Disease relapse rate was also similar (63.6% ≥ 70 vs. 60% < 70, P = 0.906). Elderly patients with good functional status and limited comorbidities diagnosed with MIBC receiving standard neoadjuvant chemotherapy followed by cystectomy or radiotherapy can have similar clinical outcomes as their younger counterparts. Prospective studies evaluating the optimum curative management in this elderly population are warranted.

Bladder cancer in the elderly patient: challenges and solutions

“…A single-institution case series demonstrated similar rates of eligibility for definitive local therapy following cisplatin-based NAC. Additionally, it reported similar clinical outcomes including pathologic CR, overall survival, and relapse-free survival at 3 years in patients aged ≥70 years versus younger patients with MIBC 42. A recent study of tolerability and efficacy of cisplatin-based combination chemotherapy in metastatic disease based on data from eight Phase II and III clinical trials with a total of 543 patients demonstrated no significant differences in the frequency of renal failure (grade 3–4), febrile neutropenia, or treatment-related death or median survival (12.1 months versus 12.8 months; P =0.91) for patients older and younger than 70 years of age 43…”

Evaluation of Neoadjuvant Chemotherapy in Treatment of Muscle Invasive Urothelial Bladder Tumors in Upper Egypt

“…In our study patient's age was significantly associated with response, as younger patients (≤60 years) responded better than older (>60 years) patients. Other researchers didn't find a significant difference between younger and older patients and concluded that any fit patient of any age group can benefit from the treatment 24 .…”

Integration of geriatric oncology in daily multidisciplinary cancer care: the time is now

“…Their findings should be transferrable to many other countries and health systems (O'Donovan et al 2015). Chau et al (2015) and Qiu et al (2015) both conducted traditional clinical trials comparing younger and older patients. The latter study looks at differences in clinicopathological features and prognosis of triple-negative breast cancer (TNBC) between younger (<60 years old) and elderly (≥60 years old) patients.…”

“…Chau et al . () and Qiu et al . () both conducted traditional clinical trials comparing younger and older patients.…”

“…Chau et al . () address clinical outcomes following neoadjuvant cisplatin‐based chemotherapy for bladder cancer in both subgroups. They suggest that older patients receiving neo‐adjuvant chemotherapy followed by cystectomy or radiotherapy can show similar clinical outcomes as younger patients if they present with a good functional ability and limited comorbidities (Chau et al .…”