IBCN 2017: Improving neoadjuvant chemotherapy for muscle invasive bladder cancer

Lisbon, Portugal (UroToday.com) Colin PN Dinney from MD Anderson, Houston, TX discussed the role of neoadjuvant chemotherapy (NAC). NAC is a guideline recommended treatment with noted significant underutilization. Clinical predictors have been used including lymphovascular invasion, hydronephrosis, cT4a, CIS and variant histology are used to determine who may benefit most from NAC. Low vs high risk had significant different survival outcomes. Moreover, molecular subtype with basal tumors performed the worse, however, respond best to NAC according to recent research. Predicting response to chemotherapy include gene alterations such as ERCC2 in addition to molecular subtypes. Moreover, in support of other recent data the MDACC group confirmed luminal subtype does not respond well to NAC with worse survival among NAC followed by surgery in this subtype. Accordingly, luminal tumors respond best to cystectomy alone, basal tumors respond well to NAC. Luminal infiltrated and claudin low tumors respond poor to either treatment. Further research is underway to clarify which patients may benefit most from NAC versus upfront surgery.

Speaker(s): Colin PN Dinney from MD Anderson, Houston, TX

Written by: Stephen B. Williams, M.D., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX., at the International Bladder Cancer Network - October 21, 2017- Lisbon, Portugal

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