Side note, chemo regimens included cisplatin/etoposide, ddMVAC, gem/cis among others. But, also the alternating IA/EP doublet regimen, which reported from MD Anderson News by my colleague Dr. Siefker-Radtke in 2008, Journal of Clinical Oncology.
At baseline (table 1), ECOG 0-1 was equal between neoadjuvant, adjuvant or no chemo groups. Median GFR was in 70-80s in neoadjuvant or adjuvant chemo groups. When we zoomed in on the 141 pts (table 2) who received neoadjuvant regimens, EP recipients were older.
Results:
– pCR was higher with neoadjuvant chemo (~50% vs ~15%)
– pCR was higher with neoadjuvant chemo (~50% vs ~15%)
– approximately 10% of neoadjuvant recipients didn’t proceed with surgery (declining PS or progression dx)
– Remaining neuroendocrine ca component was high (~80%) if neoadjuvant chemo was not used
– Remaining neuroendocrine ca component was high (~80%) if neoadjuvant chemo was not used
IA/EP a/w highest pCR rate (60%)
In exploratory analysis, pCR enriched for BRCA1/2 mutations. See paper for details.
Survival, we found the neoadjuvant chemo was associated with better survival as compared to adjuvant. This was still true in multivariable analysis. We also found that EP or IA/EP (small cell regimens) were associated with better survival as compared to ddMVAC/GC or others.
Conclusion: in this variant histology of bladder cancer, increased survival with neoadjuvant chemo rather upfront surgery. There may be a preferential path response to the small cell regimens EP or alternating IA/EP doublet. A trial would be the way to verify these findings.
Plug for ongoing trials allowing inclusion of small cell variant in early stage bladder cancer : NCT04383743 led by Petros Grivas
and Fred Hutchinson Cancer Center and NCT05312671 led by Jean Hoffman-Censits and Johns Hopkins Greenberg Bladder Cancer Institute.
Many to thank. Especially. My equal first author Nate Wilson. Special thanks to the European Urology Oncology education board, and Andrew Vickers stat editor! Check out these guides.”
Source: Omar Alhalabi/Twitter