Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy: The M.D. Anderson Cancer Center Experience

Ho, Philip Levy; Willis, Daniel; Patil, Jeevitha; Xiao, Lianchun; Williams, Stephen B.; Melquist, Jonathan; Tart, Karen; Parikh, Suhag; Shah, Jay B.; Delacroix, Scott E.; Navai, Neema; Siefker-Radtke, Arlene; Dinney, Colin P.; Pisters, Louis L.; Kamat, Ashish M.

doi:10.1016/j.urolonc.2015.08.012

Cited by 57 publications

(47 citation statements)

References 21 publications

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“…In the original trials of the MVAC regimen for the treatment of bladder cancer 40,47 , patients with suspected lymph-node involvement were included in the metastatic disease cohorts; however, patients with metastases restricted to lymph nodes or soft-tissue sites can achieve long-term disease control if they experience a major response after six cycles of cisplatin-based combination therapy and then go on to have consolidation surgery, whereas such control of disease is rarely achieved in those with do not have a major response or in patients who have visceral metastases 48–50 . An analysis of NCDB data, published by Galsky et al .…”

Section: Nact: Early Lessons Learnedmentioning

confidence: 99%

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Funt

Rosenberg

2016

Nat Rev Clin Oncol

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Many patients diagnosed with muscle-invasive bladder cancer (MIBC) will develop distant metastatic disease. Over the past three decades, perioperative cisplatin-based chemotherapy has been investigated for its ability to reduce the number of deaths from bladder cancer. Insufficient evidence is available to fully support the use of such chemotherapy in the adjuvant setting; however, neoadjuvant cisplatin-based combination chemotherapy has become a standard of care for eligible patients based on the improved disease-specific and overall survival demonstrated in two randomized phase III trials, compared with surgery alone. For patients with disease downstaging to non-MIBC at the time of radical cystectomy as a result of neoadjuvant chemotherapy, outcomes are outstanding, with 5-year overall survival of 80–90%. Nevertheless, the inability to define before treatment the patients who will and those who will not achieve such a response has impeded the achievement of better outcomes for patients with MIBC. High-throughput DNA and RNA profiling technologies might help to overcome this barrier and enable a more-personalized approach to the use of cytotoxic neoadjuvant chemotherapy. In the past 2 years, trial results have demonstrated the unprecedented ability of immune-checkpoint blockade to induce durable remissions in patients with metastatic disease that has progressed after chemotherapy; studies are now urgently needed to determine how best to incorporate this powerful therapeutic modality into the care of patients with MIBC. Herein, we review the evolution of chemotherapy and immunotherapy for muscle-invasive bladder cancer.

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Section: Nact: Early Lessons Learnedmentioning

confidence: 99%

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Funt

Rosenberg

2016

Nat Rev Clin Oncol

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“…[11][12][13][14] The current analysis adds to this literature, using, to our knowledge, the largest cohort to compare the effectiveness of various treatment strategies for cN+ disease derived from a registry representing the majority of incident cancer diagnoses in the United States, captured across the continuum of practice settings and employing strategies to address confounding.…”

Section: Treatment Effectivenessmentioning

confidence: 99%

“…[11][12][13][14] In an early analysis in 1999, Dodd et al 11 reported that among nine patients with radiographic pelvic lymph node involvement undergoing postchemotherapy cystectomy, three patients were alive at 5 years. This single-center experience was expanded by Herr et al 12 in 2001, demonstrating durable disease control in a subset of patients, particularly those achieving a partial or complete radiographic response to chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, single-center and multicenter series from academic institutions, comprising 55 to 304 patients who were treated with initial chemotherapy followed by cystectomy, reported similar results. 13,14 Although these data suggest that outcomes may be optimized with combined-modality therapy, interpretation is hampered by a lack of consideration of various treatment approaches and sequences, methodological heterogeneity, and limited generalizability. To address this major evidence gap, we performed a comparative effectiveness analysis using a large observational cohort.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness of Treatment Strategies for Bladder Cancer With Clinical Evidence of Regional Lymph Node Involvement

Galsky

Stensland

Sfakianos

et al. 2016

JCO

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Purpose Patients with bladder cancer with clinical lymph node involvement (cN+) are at high risk for distant metastases, but are potentially curable. Such patients are excluded from neoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To address this evidence void, we performed a comparative effectiveness analysis. Methods We included cTanyN1-3M0 bladder cancer patients from the National Cancer Data Base (2003-2012) treated with chemotherapy and/or cystectomy. We used multistate survival analysis, allowing for delayed entry, to assess overall survival (OS) according to various treatment strategies. Effectiveness was estimated with multivariable adjustment for tumor-, patient-, and facility-level characteristics. Results Among 1,739 patients (cN1, 48%; cN2, 45%; cN3, 7%), 1,104 underwent cystectomy and 635 were treated with chemotherapy alone. Of the cystectomy patients, 363 received preoperative and 328 received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 14% (95% CI, 11% to 17%), 19% (95% CI, 15% to 24%), 31% (95% CI, 25% to 38%), and 26% (95% CI, 21% to 34%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (hazard ratio, 0.80; 95% CI, 0.66 to 0.97). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival of patients treated with chemotherapy alone was worse than those treated with cystectomy alone. Conclusion A subset of patients with cN+ bladder cancer achieves long-term survival. Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best outcomes.

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“…In many of these studies, discrepancies between clinical and pathological staging exceeded 30% [7,18,19,21–23,32]. Since one rationale for consolidative surgical therapy in this setting is the removal of clinically undetectable microscopic disease, an imaging modality that allows for better patient selection would be of great value.…”

Section: Introductionmentioning

confidence: 99%

Role of consolidative surgical therapy in patients with locally advanced or regionally metastatic bladder cancer

Tyson¹,

Chang²,

Keegan³

2016

Bladder

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The effect of radical cystectomy and extended pelvic lymph node dissection (RC/PLND) on the survival of patients with locally advanced and/or regionally metastatic bladder cancer is unknown. However, emerging evidence suggests that there may be survival benefit to a subset of select patients with this disease who demonstrate a response to chemotherapy. This article will review the current literature on the role of RC/PLND in the consolidative treatment of locally advanced and regionally metastatic bladder cancer.

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Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy: The M.D. Anderson Cancer Center Experience

Cited by 57 publications

References 21 publications

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Systemic, perioperative management of muscle-invasive bladder cancer and future horizons

Comparative Effectiveness of Treatment Strategies for Bladder Cancer With Clinical Evidence of Regional Lymph Node Involvement

Role of consolidative surgical therapy in patients with locally advanced or regionally metastatic bladder cancer

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