Quality of pathologic response and surgery correlate with survival for patients with completely resected bladder cancer after neoadjuvant chemotherapy

Sonpavde, Guru; Goldman, Bryan; Speights, V. O.; Lerner, Seth P.; Wood, David P.; Vogelzang, Nicholas J.; Trump, Donald L.; Natale, Ronald B.; Grossman, H. Barton; Crawford, E. David

doi:10.1002/cncr.24466

Cited by 181 publications

(117 citation statements)

References 30 publications

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“…2,3,10,11 Pathological stage is an important prognostic factor for patients undergoing RC for bladder cancer. 4,20,21 Patients with pathologically organ-confined disease at RC (stage <pT3a, pN0) generally have a more favourable prognosis. 4,21 Median OS for those who achieve stage pT0 was 13.6 years in the sub-analysis of SWOG87-10.…”

Section: Discussionmentioning

confidence: 99%

“…4,21 Median OS for those who achieve stage pT0 was 13.6 years in the sub-analysis of SWOG87-10. 20 The fact that there is a greater rate of pathologic down-staging with NAC and that lower pathological stage correlates with an improvement in median survival are critical considerations in the management of muscle invasive urothelial carcinoma of the bladder. More than 3 times as many patients in the NA GC group compared to the untreated group had non-invasive urothelial carcinoma of the bladder.…”

Section: Discussionmentioning

confidence: 99%

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Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

El-Gehani

North²,

Ghosh³

et al. 2014

CUAJ

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Introduction: Neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy (RC) for muscle invasive urothelial carcinoma of the bladder improves survival. This study was undertaken to determine the rate of neoadjuvant gemcitabine and cisplatin use prior to RC and to assess its effect on the pathologic response rates and cancer-specific survival (CSS) and overall survival (OS). Methods: This retrospective chart review examined all patients having a RC between January 1, 2007 and June 30, 2011. We collected patient demographics, pre-treatment clinical stage, type of chemotherapy, post-RC pathologic data and survival data. Results: A total of 251 RC were performed of which 160 were for stage cT2-T4 urothelial carcinoma of the bladder. Of the 160 patients, 91 (57%) received neoadjuvant gemcitabine and cisplatin (GC) and 69 (43%) went straight to RC. Patients receiving neoadjuvant GC had a greater chance of achieving a pathologically lower stage compared to the untreated population: pT0 at 21% vs. 3%; non-invasive cancer at 37% vs. 10%; and organ-confined cancer at 60% vs. 33% (p < 0.001). Survival correlated with pathological stage: ≤pT3a patients had a median OS and CSS of 48.8 and 51.2 months compared to an OS and a CSS in ≥pT3b patients of 21.8 and 28.1 months, respectively (p < 0.0001). Conclusions: Neoadjuvant chemotherapy for urothelial carcinoma of the bladder is more frequently administered at our institution compared to the published literature. We have found that neoadjuvant chemotherapy increases the rate of down-staging, which is associated with a reduced the risk of death from urothelial carcinoma of the bladder.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

El-Gehani

North²,

Ghosh³

et al. 2014

CUAJ

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“…A growing body of evidence suggests that pCR is a surrogate marker for survival in urothelial carcinoma. In a retrospective analysis of the SWOG 8710 trial, Sonpavde and colleagues (35) showed that residual disease after neoadjuvant chemotherapy and incomplete node dissection (<10 nodes removed) were linked to worse prognosis. Both clinical stage at diagnosis and pathologic stage at radical cystectomy were predictive of OS.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

New Directions for Biologic Targets in Urothelial Carcinoma

Richter

Sridhar

2012

Molecular Cancer Therapeutics

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Urothelial carcinoma remains an important oncologic problem with significant morbidity and mortality. This article provides an overview of the current status of treatment of urothelial carcinoma, with an update on current trials and recent American Society of Clinical Oncology abstracts. As an alternative to focusing on the metastatic setting, we take a broad look at drug development to date, as it spans from early disease to advanced disease in the context of emerging molecular data. This approach allows us to show that each stage involves key considerations based on emerging evidence regarding molecular biology, stage-specific novel endpoints, and rational patient selection that may help further trial designs in the future. Key issues, such as neoadjuvant versus adjuvant perioperative chemotherapy, approaches to salvage second-line therapy in the metastatic setting, and treatment of elderly and cisplatin-ineligible patients, are discussed. New paradigms in clinical research, including novel endpoints, upfront rational patient selection, biomarkers, and trial design, are also addressed. Mol Cancer Ther; 11(6); 1226-35. Ó2012 AACR.

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“…Two meta-analyses demonstrated a 5% overall benefit at five years for platinum-based pre-operative treatment versus cystectomy alone (5,6). The efficacy of neoadjuvant chemotherapy is associated with primary tumor downstaging, which is considered a potential surrogate for survival (7)(8)(9). Despite the advantages, the preoperative treatment is not yet largely employed due to concerns about delaying curative surgery for chemotherapy side effects and increasing surgical complications (10).…”

mentioning

confidence: 99%

“…Despite the advantages, the preoperative treatment is not yet largely employed due to concerns about delaying curative surgery for chemotherapy side effects and increasing surgical complications (10). Furthermore, several studies on neoadjuvant chemotherapy included cT2N0 patients (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), with a low risk of recurrence only with radical cystectomy (15). Chemotherapy could be an overtreatment for this stage of disease.…”

mentioning

confidence: 99%

Neoadjuvant Chemotherapy for Patients with Muscle-invasive Urothelial Bladder Cancer Candidates for Curative Surgery: A Prospective Clinical Trial Based on Cisplatin Feasibility

Schinzari

Monterisi

Pierconti

et al. 2017

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Quality of pathologic response and surgery correlate with survival for patients with completely resected bladder cancer after neoadjuvant chemotherapy

Cited by 181 publications

References 30 publications

Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

New Directions for Biologic Targets in Urothelial Carcinoma

Neoadjuvant Chemotherapy for Patients with Muscle-invasive Urothelial Bladder Cancer Candidates for Curative Surgery: A Prospective Clinical Trial Based on Cisplatin Feasibility

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