Incremental utility of adjuvant chemotherapy in muscle-invasive bladder cancer: Quantifying the relapse risk associated with therapeutic effect Journal Article


Authors: Pederzoli, F.; Bandini, M.; Briganti, A.; Plimack, E. R.; Niegisch, G.; Yu, E. Y.; Bamias, A.; Agarwal, N.; Sridhar, S. S.; Sternberg, C. N.; Vaishampayan, U. N.; Théodore, C.; Rosenberg, J. E.; Harshman, L. C.; Bellmunt, J.; Galsky, M. D.; Gallina, A.; Salonia, A.; Montorsi, F.; Necchi, A.; on behalf of the RISC Investigators
Article Title: Incremental utility of adjuvant chemotherapy in muscle-invasive bladder cancer: Quantifying the relapse risk associated with therapeutic effect
Abstract: The availability of new potent systemic therapies for urothelial carcinoma may change the way we use standard chemotherapy perioperatively. In particular, identifying which patients with muscle-invasive bladder cancer (MIBC) would benefit from adjuvant chemotherapy (AC) is compelling. From a multicenter database we selected 950 patients with cT2–4N0M0 MIBC treated with radical cystectomy (RC), with or without neoadjuvant chemotherapy (NAC), and AC. We used Kaplan-Meier analyses to test 1-yr recurrence-free survival (RFS) rates according to AC use. Nomogram-derived probabilities of 1-yr recurrence after RC were plotted against actual recurrence rates according to AC use. Overall, we did not see evidence of an AC effect on the 1-yr RFS rate (p = 0.6). Conversely, the 1-yr RFS rate was higher among patients with pT3–4 or pN1 disease who received AC (75% vs 54%; p < 0.001). We were unable to demonstrate a difference between AC and no AC among patients who received prior NAC (1-yr RFS 57% vs 76%; p = 0.057). As the most important finding, AC was associated with incremental RFS benefits only for patients with a nomogram-derived 1-yr recurrence probability of >40%. Patient summary: Maximizing disease control with adjuvant chemotherapy was beneficial for patients with muscle-invasive bladder cancer who had a calculated recurrence risk of >40% and did not impact cancer recurrence in lower-risk disease. Therefore, patient stratification using the nomogram available for predicting recurrence is advisable pending external validation. © 2019 European Association of Urology Adjuvant chemotherapy after neoadjuvant treatment and radical cystectomy for muscle-invasive bladder cancer should be offered only to patients with a high risk of 1-yr recurrence. Time-based endpoints may be more useful to help data interpretation for the next adjuvant and neoadjuvant immunotherapy studies. © 2019 European Association of Urology
Keywords: immunotherapy; adjuvant chemotherapy; nomogram; recurrence-free survival; muscle-invasive bladder cancer
Journal Title: European Urology
Volume: 76
Issue: 4
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2019-10-01
Start Page: 425
End Page: 429
Language: English
DOI: 10.1016/j.eururo.2019.06.032
PUBMED: 31303258
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 October 2019 -- Source: Scopus
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MSK Authors
  1. Jonathan Eric Rosenberg
    240 Rosenberg