ASCO GU 2017: Barriers in Progress in Muscle-Invasive and Non-muscle Invasive Bladder Cancer

Orlando, Florida USA (UroToday.com) Maria De Santis, University of Warwick, discussed neoadjuvant chemotherapy (NAC). There is a 14% decreased risk of death associated with use of NAC and are included as recommended treatment in EAU/ASCO guidelines. Therapies include dose dense or accelerated MVAC (dd-MVAC) regimens as well as GC or GC split dose regimens. Which schedule is superior and which has least toxicity? Downstaging to pT0 is approximately 34-38% for all regimens MVAC and dd-MVAC. GC with or without split dose vs MVAC are equivalent as well ranging between 29-31%. Split dose GC is well tolerated with 82% completing the scheduled regimen. dd-MVAC has minimal toxicity with up to 93% completing all 3 cycles as noted by Plimack et al. in her 2014 Journal of Clinical Oncology article. NAC with GC has minimal change in renal function duration scheduled treatments. As noted in the Grossman et al. 2003 publication there is no significant delay to surgery associated with use of NAC MVAC. Moreover, recent data from single institution and large population-based database registries do not show significantly increased morbidity or prolonged hospital stay when patients undergo radical cystectomy with or without NAC. The price of NAC are potential short and long-term toxicity and need for improved patient selection for NAC versus upfront surgery.

Presenter: Maria De Santis, University of Warwick

Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA

Login