Neoadjuvant Chemotherapy Use for Muscle Invasive Bladder Cancer in an Elderly Population
Randie E. White, MD, Joshua A. Linscott, MD, PhD, Nathanial Hansen, MD, Jesse Sammon, DO, Matthew T. Hayn, MD, Stephen T. Ryan, MD.
Maine Medical Center, PORTLAND, ME, USA.
BACKGROUND: Radical Cystectomy (RC) is standard of care for Muscle Invasive Bladder Cancer (MIBC). For eligible patients, Neoadjuvant Chemotherapy (NAC) adds a small but significant survival benefit. Our group provides >80% of all RC care in the state. We examined the impact of NAC on overall survival amongst our patient population as well as a sub-population of patients 75 and older. METHODS: A prospectively maintained RC database was reviewed. 195 MIBC patients with complete follow-up were identified from 2015-2022. NAC chemotherapy regimens were administered in accordance with guidelines. Patients who completed a full course of NAC were compared to those with either no NAC or an incomplete NAC. 65 patients were identified who were ≥75. Survival analysis of the entire cohort was compared, followed by analysis of the elderly cohort. Overall survival and disease specific survival (DSS) were compared by Kaplan-Meier analysis. Predictions of OS were compared with cox regression, covariates included BMI>30, sex, current tobacco use, Charleston Comorbidity index (CCI)>2, age, and high-grade complication. RESULTS: 125 of 195 (74.1%) patients received a full course of NAC, 43 (34.4%) achieved complete response (CR). NAC patients were younger with a higher BMI, more likely smokers and had lower stage on final pathology (Table 1a). NAC was associated with an OS advantage, with median survival 80.3 mo vs 28.3 mo. After adjusting for covariates, NAC was significantly associated with OS, HR=(.554, 0.313-0.982). CR was associated with improved OS (Figure 1b). There was no difference in DSS for the entire cohort. For patients ≥75, 22 of 65 (33.8%) received a full course of NAC. There was a striking difference in localized cancer on final pathology (66% vs 33%, p<0.001) (Table 1b). There was a separation of OS with the receipt of NAC but it was not statistically significant (p=0.06, Figure 1c). Curves also show separation based on final pathology (Figure 1d, p=0.065). CONCLUSIONS: We noted an overall survival advantage for patients who received NAC and a clear trend for improved survival based on final pathology. Most series have reported low rates of NAC administration (~30-50%) and in younger cohorts (mean age <70). We have an older population with the majority receiving a full course of NAC. Here we show patients ≥75 who receive NAC have significantly less advanced disease. We conclude that NAC should be given in accordance with guidelines for whomever is eligible, regardless of age.
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