Omar Alhalabi: Advancing Knowledge on Aggressive Bladder Cancer Subtypes
Omar Alhalabi, Genitourinary Medical Oncologist at MD Anderson Cancer Center, shared an X:
“Hot off the press. Excited to share work done by stellar Society of Urologic Oncology fellow Amanda Myers, mentored by Ashish M. Kamat. Further advancing knowledge on aggressive bladder cancer subtypes. T1 nonmuscle invasive small cell neuroendocrine carcinoma.
The current NCCN guidelines for bladder cancer has the same recommendation for localized small cell or NE features including non muscle invasive disease but to our knowledge this has not been reported in a dedicated study before.
Therefore, we looked at those with T1, captured muscle on TUR but no disease involvement of muscularis propria. We noticed the expected shift in practice to use neoadj chemotherapy especially 2013 onwards.
We noticed a better odds of path complete response or downstaging and less odds of metastatic relapse in those who received neoadj chemotherapy. This was reflected on OS and PFS analysis despite the small numbers.
The T1 group combined (with or without neoadj chemo) still does better overall than T2+ suggesting a possible role for muscle invasion in affecting prognosis even in small cell subtype. See supplementary for multivariable analysis.
This paper supports the current NCCN recommendation and in my mind raises the question for potential role for systemic therapy in other rare aggressive subtypes as well such as nonmuscle invasive plasmacytoid subtype. I think ctDNA status may help us here.
Grateful to our urology, pathology and radiation oncology colleagues and collaborators who play a vital role in helping our bladder cancer community.
A big thank you to the editorial board (esp. Dr. Choueiri) and reviewers for the thoughtful suggestions to get the paper where it is.”
Impact of systemic therapy on clinical T1 small-cell neuroendocrine carcinoma of the bladder
Authors: A.A. Myers, A.M. Fang, M.J. Moussa, H. Hwang, N.R. Wilson, M.T. Campbell, P. Msaouel, B.H. Lee, C.C. Guo, M. Zhang, J. Zhao, A.O. Siefker-Radtke, A.M. Kamat, O. Alhalabi
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