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WASHINGTON, DC—Patients who achieve a clinical complete response to neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) remain at risk for recurrence of nonmuscle-invasive disease, according to data presented at the Society of Urologic Oncology’s 24th Annual Meeting.
The finding is from a retrospective review of a prospectively maintained database of all patients on a clinical complete response surveillance protocol. To be in this protocol, patients must have received platinum-based NAC for MIBC followed by negative cross-sectional imaging, negative cytology, and negative post-NAC maximal endoscopic resection, first author Benjamin I. Joffe, MD, of Columbia University’s Irving Medical Center in New York, New York, and colleagues explained in a poster presentation.
At his center, Dr Joffe said, clinicians offer patients who have a clinical complete response after NAC the option of entering an active surveillance protocol while acknowledging that radical cystectomy after NAC is still the standard of care. The protocol includes cystoscopy/cytology every 3 months and cross-sectional imaging every 6 months.
“These patients have some risk of mortality, but it’s very similar to the actual risk of cystectomy mortality,” Dr Joffe said.
The review included 61 patients with a clinical complete response. Of these, 14 (23%) had a history of prior nonmuscle-invasive bladder cancer (NMIBC). The median time in the surveillance protocol was 28.3 months. Dr Joffe and colleagues considered patients to have a durable response if they had no MIBC or metastatic recurrence, even if they recurred with NMIBC.
Overall, 49 patients (80%) maintained a durable response, but 28 patients (46%) experienced a median of 1 NMIBC recurrence, with 20 patients (33%) having 1 recurrence, 5 (8%) having 2 recurrences, and 3 (5%) having 3 or more recurrences. The median time to recurrence was 11.5 months.
Of the total 46 recurrences, 9 (20%) were low-grade Ta, 11 (24%) were high-grade Ta, 9 (20%) were high-grade T1, and 17 (37%) were carcinoma in situ.
All of the low-grade Ta recurrences were treated with transurethral resection (TUR) alone. High-grade recurrences were treated with BCG in 22 cases (59%), induction chemotherapy in 1 (3%), TUR alone in 4 (11%), and cystectomy in 7 (19%).
Patients who experienced NMIBC recurrence were not at higher risk to recur with muscle-invasive or metastatic disease, Dr Joffe reported. Most patients were able to continue bladder-sparing treatment and avoid cystectomy.
The findings are important for appropriately counseling patients that even if they have a clinical complete response, they still have a substantial risk for NMIBC recurrence and require careful surveillance, the investigators concluded.
Reference
Joffe BI, Laplaca C, Chung R, et al. Non-muscle invasive recurrence and management during surveillance in patients with muscle-invasive bladder cancer who achieve clinical complete response to neoadjuvant chemotherapy. Presented at: SUO 2023; November 28-December 1, Washington, DC. Poster 77.
This article originally appeared on Renal and Urology News
