Princess Margaret Cancer Center - University Health Network
Patient trajectories of a real-world cohort initiating neoadjuvant chemotherapy for localized muscle-invasive bladder cancer: A population-based study analyzed by a multi-state modelling framework
Marian S. Wettstein1,2,3, Song Pham2, Syed R. Qadri1, Kathy Li1, Ning Liu2, Thomas Hermanns3, Peter W. Chung4, Srikala S. Sridhar5, Girish S. Kulkarni1,2.
1Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada; 2ICES, Toronto, ON, Canada; 3Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; 4Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada; 5Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
Introduction: The use of neoadjuvant chemotherapy (NAC) for localized muscle-invasive bladder cancer (MIBC) is supported by level-1 evidence. Opponents of NAC suggest missing a window of opportunity to deliver definitive radical therapy due to NAC-related toxicity or NAC-unresponsive disease. The aim of the current study was to investigate the proportion of patients initiating NAC who actually go on to receive definitive radical therapy for localized MIBC.
Methods: Province-wide bladder cancer pathology reports (April 2004 to December 2015; Ontario, Canada) were linked to the Cancer Activity Level Reporting database to derive a cohort of patients diagnosed with localized MIBC who had at least one administration of systemic therapy with neoadjuvant intent. Patients were followed for the receipt of radical cystectomy, initiation of trimodal therapy, or the occurrence of death (cause-specific). A multi-state modelling framework was utilized to describe the trajectory of these patients (see Figure 1).
Results: We identified a cohort of 485 patients with a median age of 67 years (interquartile range: 60-73 years). A majority of all patients (N=422, 89.3%) received a NAC regimen containing at least one dose of cisplatin. Six months after NAC initiation, the probabilities to have received radical cystectomy, to have initiated trimodal therapy, to have died of bladder cancer, to have died of other causes, and to be alive without having received any definitive radical therapy were 36.6%, 3.5%, 4.2%, 3.9%, and 51.8%, respectively. Five years after the receipt of definitive radical therapy, the probabilities to have died of bladder cancer/other causes were 25.4%/29.6% (radical cystectomy) and 15.2%/45.5% (trimodal therapy).
Conclusions: In a real-world cohort that initiated NAC for MIBC, only about 40% of all patients will ultimately receive definitive radical therapy after six months. This study provides realistic estimates for patients being counseled about NAC in MIBC.
21:45 - 22:15
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