(UroToday.com) The 2024 South Central AUA annual meeting included a session on bladder cancer, featuring a presentation by Dr. Gal Saffati discussing a systematic review and meta-analysis of early adjuvant chemotherapy in muscle invasive bladder cancer. Muscle invasive bladder cancer necessitates a comprehensive treatment approach, typically commencing with neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy and pelvic lymph node dissection. The efficacy of neoadjuvant chemotherapy in muscle invasive bladder cancer patients has been substantiated through randomized clinical trials, demonstrating improved median overall survival and enhanced pathological downstaging when compared to surgery alone.1 However, there are scenarios where upfront cystectomy and adjuvant chemotherapy may be considered. Dr. Saffati and colleagues sought to evaluate whether earlier administration of adjuvant chemotherapy can significantly augment survival rates in this specific patient population.
This study systematically searched PubMed, Cochrane Central, Scopus, and Web of Science library databases for original articles that looked at the relationship between the timing of adjuvant therapy and oncologic outcomes, including overall survival and progression free survival. Two authors independently extracted and analyzed data, heterogeneity was assessed using Higgins I2%, with values over 50% considered heterogeneous and analyzed with a random effects model. Otherwise, a fixed effects model was used. The first subgroup analysis involved stratifying studies based on a 90 day cutoff for initiating adjuvant chemotherapy, while the second utilized a 45 day cutoff.
A total of 4 retrospective studies were included and overall survival was reported in all of the included studies:
Meta-analysis of all included studies revealed a significantly increased HR of 1.27 (95% CI 1.13, 1.42), suggesting immediate adjuvant chemotherapy increased overall survival. When analyzing analyses stratified by timing of the therapy, the 90 day cutoff had a pooled HR of 1.27 (95% CI, 1.06, 1.52), while the 45-day cutoff had a HR of 1.27 (95% CI 1.10, 1.47):
Additionally, earlier adjuvant chemotherapy improved progression free survival (HR 1.77, 95% CI 1.37, 2.28):
Dr. Saffati concluded his presentation by discussing a systematic review and meta-analysis of early adjuvant chemotherapy in muscle invasive bladder cancer with the following take-home points:
- The timing of adjuvant chemotherapy post-radical cystectomy influences survival outcomes in patients with muscle invasive bladder cancer
- A survival benefit was seen with earlier administrations of adjuvant chemotherapy
- It may be safe and ethical to offer adjuvant chemotherapy as early in the postoperative period as possible, given the known survival benefit of such therapy
- Further investigations into the timing of adjuvant immunotherapy are needed to quantify data on diseases specific survival and overall survival in the context of immunotherapy
Presented by: Gal Saffati, Baylor College of Medicine, Houston, TX
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 South Central American Urological Association (AUA) Annual Meeting, Colorado Springs, CO, Wed, Oct 30 – Sat, Nov 2, 2024.
References:
- Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003;349(9):859-866.