Patterns of chemotherapy use in muscle-invasive bladder cancer in a tertiary centre Patterns of chemotherapy use in MIBC

Main Article Content

Kylie Yen-Yi Lim
Kevin Chu
Nieroshan Rajarubendra
James Huang
David Pook
Paul Manohar
Matthew Harper
Scott Donnellan
Weranja Ranasinghe

Keywords

Adjuvant chemotherapy, chemotherapy, cystectomy, neoadjuvant therapy, muscle-invasive bladder cancer

Abstract

Objectives: Although neoadjuvant chemotherapy (NAC) has been demonstrated to have significant benefits to survival in patients with muscle-invasive bladder cancer (MIBC), the current utilization of NAC in Australia is unknown. The aim of this study was to evaluate the patterns of neoadjuvant and adjuvant chemotherapy (AC) use in patients undergoing cystectomy for MIBC at a large tertiary institution in Australia.


Methods: A retrospective study was conducted using data of patients who underwent a radical cystectomy (RC) at a high-volume centre for MIBC between 2011 and 2021.


Results: Of 69 patients who had a cystectomy for ≥ pT2 bladder cancer, 73.9% were eligible for NAC. However, of those eligible, only five patients received NAC (9.8%). Of the total patients who were eligible for AC, only 44.4% received postoperative chemotherapy. Common reasons for the lack of uptake were due to patients being unfit or declining treatment. There was no difference in progression-free survival or overall survival in those who received NAC and AC.


Conclusions: The majority of patients undergoing RC for MIBC received AC compared to NAC, reflecting the real-world challenge of NAC uptake. This highlights the need for ongoing improvements in selection and usage of NAC and less reliance of AC utilization post RC.

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References

1. Advanced Bladder Cancer Meta-analysis C. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet. 2003;361(9373):1927-34. Epub 2003/06/13. https://doi.org/10.1016/s0140-6736(03)13580-5. PubMed PMID: 12801735.
2. Eldefrawy A, Soloway MS, Katkoori D, Singal R, Pan D, Manoharan M. Neoadjuvant and adjuvant chemotherapy for muscle-invasive bladder cancer: The likelihood of initiation and completion. Indian J Urol. 2012;28(4):424-6. Epub 2013/03/02. https://doi.org/10.4103/0970-1591.105756. PubMed PMID: 23449818.
3. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol. 2017;198(3):552-9. Epub 2017/05/01. https://doi.org/10.1016/j.juro.2017.04.086. PubMed PMID: 28456635.
4. Witjes JA, Bruins HM, Cathomas R, Comperat EM, Cowan NC, Gakis G, et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines. Eur Urol. 2021;79(1):82-104. Epub 2020/05/04. https://doi.org/10.1016/j.eururo.2020.03.055. PubMed PMID: 32360052.
5. Flaig TW, Spiess PE, Abern M, Agarwal N, Bangs R, Boorjian SA, et al. NCCN Guidelines(R) Insights: Bladder Cancer, Version 2.2022. J Natl Compr Canc Netw. 2022;20(8):866-78. Epub 2022/08/11. https://doi.org/10.6004/jnccn.2022.0041. PubMed PMID: 35948037.
6. Powles T, Bellmunt J, Comperat E, De Santis M, Huddart R, Loriot Y, et al. Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(3):244-58. Epub 2021/12/04. https://doi.org/10.1016/j.annonc.2021.11.012. PubMed PMID: 34861372.
7. Raphael MJ, Booth CM. Neoadjuvant chemotherapy for muscle-invasive bladder cancer: Underused across the 49(th) parallel. Can Urol Assoc J. 2019;13(2):29-31. Epub 2019/02/06. https://doi.org/10.5489/cuaj.5827. PubMed PMID: 30721125.
8. Koshkin VS, Grivas P. Perioperative chemotherapy for muscle-invasive bladder cancer: the importance of multidisciplinary management for evidence-based practice and transformative research. Transl Androl Urol. 2018;7(3):504-7. Epub 2018/07/28. https://doi.org/10.21037/tau.2018.06.03. PubMed PMID: 30050808.
9. Advanced Bladder Cancer Meta-analysis Collaborators G. Adjuvant Chemotherapy for Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis of Individual Participant Data from Randomised Controlled Trials. Eur Urol. 2022;81(1):50-61. Epub 2021/11/23. https://doi.org/10.1016/j.eururo.2021.09.028. PubMed PMID: 34802798.
10. Donat SM, Shabsigh A, Savage C, Cronin AM, Bochner BH, Dalbagni G, et al. Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: a high-volume tertiary cancer center experience. Eur Urol. 2009;55(1):177-85. Epub 2008/07/22. https://doi.org/10.1016/j.eururo.2008.07.018. PubMed PMID: 18640770.
11. McFerrin C, Davaro F, May A, Raza S, Siddiqui S, Hamilton Z. Trends in utilization of neoadjuvant and adjuvant chemotherapy for muscle invasive bladder cancer. Investig Clin Urol. 2020;61(6):565-72. Epub 2020/09/29. https://doi.org/10.4111/icu.20200132. PubMed PMID: 32985142.
12. Millar JL, Frydenberg M, Toner G, Syme R, Thursfield V, Giles GG, et al. Management of muscle-invasive bladder cancer in Victoria, 1990-1995. ANZ J Surg. 2006;76(3):113-9. Epub 2006/04/22. https://doi.org/10.1111/j.1445-2197.2006.03665.x. PubMed PMID: 16626343.
13. Galsky MD, Hahn NM, Rosenberg J, Sonpavde G, Hutson T, Oh WK, et al. Treatment of patients with metastatic urothelial cancer "unfit" for Cisplatin-based chemotherapy. J Clin Oncol. 2011;29(17):2432-8. Epub 2011/05/11. https://doi.org/10.1200/JCO.2011.34.8433. PubMed PMID: 21555688.
14. Dall'Era MA, Cheng L, Pan CX. Contemporary management of muscle-invasive bladder cancer. Expert Rev Anticancer Ther. 2012;12(7):941-50. Epub 2012/08/01. https://doi.org/10.1586/era.12.60. PubMed PMID: 22845409.
15. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228-47. Epub 2008/12/23. https://doi.org/10.1016/j.ejca.2008.10.026. PubMed PMID: 19097774.
16. Booth CM, Siemens DR, Li G, Peng Y, Tannock IF, Kong W, et al. Perioperative chemotherapy for muscle-invasive bladder cancer: A population-based outcomes study. Cancer. 2014;120(11):1630-8. Epub 2014/04/16. https://doi.org/10.1002/cncr.28510. PubMed PMID: 24733278.
17. David KA, Milowsky MI, Ritchey J, Carroll PR, Nanus DM. Low incidence of perioperative chemotherapy for stage III bladder cancer 1998 to 2003: a report from the National Cancer Data Base. J Urol. 2007;178(2):451-4. Epub 2007/06/15. https://doi.org/10.1016/j.juro.2007.03.101. PubMed PMID: 17561135.
18. Macleod LC, Yabes JG, Yu M, Fam MM, Hale NE, Turner RM, 2nd, et al. Trends and appropriateness of perioperative chemotherapy for muscle-invasive bladder cancer. Urol Oncol. 2019;37(7):462-9. Epub 2019/05/06. https://doi.org/10.1016/j.urolonc.2019.04.006. PubMed PMID: 31053530.
19. Lu Z, Clement JM, Pan Q, Swede H, Mehta R, Wang X. Patterns and predictors of treatment in muscle-invasive bladder cancer (MIBC): A real-world study. Journal of Clinical Oncology. 2021;39(15_suppl):e16531-e.
20. Walker M, Doiron RC, French SD, Brennan K, Feldman-Stewart D, Siemens DR, et al. Peri-Operative Chemotherapy for Bladder Cancer: A Survey of Providers to Determine Barriers and Enablers. Bladder Cancer. 2018;4(1):49-65. Epub 2018/02/13. https://doi.org/10.3233/BLC-170148. PubMed PMID: 29430507.
21. Boeri L, Soligo M, Frank I, Boorjian SA, Thompson RH, Tollefson M, et al. Delaying Radical Cystectomy After Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer is Associated with Adverse Survival Outcomes. Eur Urol Oncol. 2019;2(4):390-6. Epub 2019/07/07. https://doi.org/10.1016/j.euo.2018.09.004. PubMed PMID: 31277775.
22. Mmeje CO, Benson CR, Nogueras-Gonzalez GM, Jayaratna IS, Gao J, Siefker-Radtke AO, et al. Determining the optimal time for radical cystectomy after neoadjuvant chemotherapy. BJU Int. 2018;122(1):89-98. Epub 2018/03/24. https://doi.org/10.1111/bju.14211. PubMed PMID: 29569824.
23. Zargar H, Espiritu PN, Fairey AS, Mertens LS, Dinney CP, Mir MC, et al. Multicenter assessment of neoadjuvant chemotherapy for muscle-invasive bladder cancer. Eur Urol. 2015;67(2):241-9. Epub 2014/09/27. https://doi.org/10.1016/j.eururo.2014.09.007. PubMed PMID: 25257030.
24. Lee HW, Kwon WA, Nguyen NT, Phan DTT, Seo HK. Approaches to Clinical Complete Response after Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer: Possibilities and Limitations. Cancers (Basel). 2023;15(4). Epub 2023/02/26. https://doi.org/10.3390/cancers15041323. PubMed PMID: 36831665.
25. Culp SH, Dickstein RJ, Grossman HB, Pretzsch SM, Porten S, Daneshmand S, et al. Refining patient selection for neoadjuvant chemotherapy before radical cystectomy. J Urol. 2014;191(1):40-7. Epub 2013/08/06. https://doi.org/10.1016/j.juro.2013.07.061. PubMed PMID: 23911605.
26. Buttigliero C, Tucci M, Vignani F, Scagliotti GV, Di Maio M. Molecular biomarkers to predict response to neoadjuvant chemotherapy for bladder cancer. Cancer Treat Rev. 2017;54:1-9. Epub 2017/01/31. https://doi.org/10.1016/j.ctrv.2017.01.002. PubMed PMID: 28135623.
27. Choi SY, Ha MS, Chi BH, Kim JW, Chang IH, Kim TH, et al. Neoadjuvant versus adjuvant chemotherapy in bladder cancer: a nationwide cohort study. J Cancer Res Clin Oncol. 2022;148(11):3135-44. Epub 2022/01/22. https://doi.org/10.1007/s00432-022-03926-1. PubMed PMID: 35061097.
28. Nadal R, Apolo AB. Overview of Current and Future Adjuvant Therapy for Muscle-Invasive Urothelial Carcinoma. Curr Treat Options Oncol. 2018;19(7):36. Epub 2018/05/29. https://doi.org/10.1007/s11864-018-0551-z. PubMed PMID: 29808294.
29. Leow JJ, Martin-Doyle W, Rajagopal PS, Patel CG, Anderson EM, Rothman AT, et al. Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials. Eur Urol. 2014;66(1):42-54. Epub 2013/09/11. https://doi.org/10.1016/j.eururo.2013.08.033. PubMed PMID: 24018020.

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