The administration of neoadjuvant chemotherapy plus radical cystectomy significantly improved the rate of overall survival (OS) among patients with early-stage small cell bladder cancer compared with trimodality therapy, according to findings from a study. 

Karan Jatwani, MD, Roswell Park Comprehensive Cancer Center, Buffalo, NY, presented results on Friday, February 17, 2023, at the 2023 ASCO Genitourinary Cancers Symposium in San Francisco, CA. 

Both neoadjuvant chemotherapy plus radical cystectomy and maximal transurethral resection of bladder tumor plus chemoradiation (trimodality therapy) “have been variably employed based on institutional preferences,” Dr Jatwani and colleagues wrote. However, there is “a paucity of data to guide the optimal management strategy.” 

This study included 1262 adult patients with early-stage small cell node-negative bladder cancer and diagnosed within the years 2004 to 2018 from the National Cancer Database. Patients were divided into 2 groups: those who received neoadjuvant chemotherapy plus radical cystectomy (n = 629 patients; 49.8%), and those who received trimodality therapy (n = 633; 50.2%). 

With a median follow-up duration of 19 months for the neoadjuvant chemotherapy plus radical cystectomy cohort and 17 months for the trimodality therapy cohort, median OS was significantly longer in the neoadjuvant chemotherapy plus radical cystectomy cohort compared with the TMT cohort (41.3 months vs 25.4 months respectively; P < .001). According to multivariable analysis, the type of treatment modality employed was the only independently predictive factor of overall survival (hazard ratio [HR]: 1.22 for TMT cohort; 95% CI, 1.05 to 1.43; P = .01). 

Dr. Jatwani and co-authors concluded, “In early-stage clinically node-negative small cell bladder cancer, [neoadjuvant chemotherapy plus radical cystectomy] was associated with significantly longer overall survival compared to [trimodality therapy].”

Source:

Karan J, Roy AM, Attwood K, et al. Neoadjuvant chemotherapy plus radical cystectomy (NAC-RC) versus trimodality therapy (TMT) in early-stage small cell bladder cancer: Comparison of outcomes. Presented at the 2023 ASCO Genitourinary Cancer Symposiums; February 16-18; San Francisco, CA. Abstract 476.