(UroToday.com) The 2024 IBCN annual meeting included a bladder cancer session, featuring a presentation by Dr. John Sfakianos discussing how undetectable ctDNA status before radical cystectomy predicts improved outcomes. Tumor-informed circulating ctDNA has emerged as a novel biomarker in patients with urothelial cancer, and ctDNA can aid in clinical decision-making for the use of neoadjuvant or adjuvant treatments for patients undergoing radical cystectomy.
This study sought to assess the predictive abilities of ctDNA status on pathological outcomes, and the prognostic utility of evaluating ctDNA dynamics before and after radical cystectomy recurrence-free survival.
In this study, consecutive patients who underwent radical cystectomy from 2021-2023 had prospectively and longitudinally collected ctDNA tumor-informed assays. Logistic regression models were constructed to find predictors for pathological outcomes after radical cystectomy, and survival analyses were undertaken using the Kaplan-Meier method and log-rank test to as recurrence-free survival for patients that had more than 3 months of follow-up. Pairwise comparisons were corrected using the Benjamini-Hochberg method.
Overall, there were 134 patients with a median age of 71 (IQR 63-77) included in this study:
Clinically, 85 (63.4%) of patients had muscle-invasive bladder cancer (>=cT2) and of them, 25 (29.4%) had neoadjuvant treatment. At a median follow-up of 10 months (IQR 6-17), 40 (29.9%) of patients had disease relapse. Patients with an undetectable ctDNA had recurrence-free survival compared to those with detectable ctDNA (log-rank, p<0.0001), with12-months median recurrence-free survival of 93% (95% CI 86-100) versus 40% (95% CI 27-59), respectively. Patients with undetectable ctDNA had a bettrecurrence-free survival regardless of clinical T stage (<T1 vs >=T2) or upfront cystectomy versus neoadjuvant treatment:
Patients with persistently undetectable ctDNA in the pre-and post-radical cystectomy period had bettrecurrence-free survival than patients with persistently detectable (p < 0.001), and patients who converted from detectable to undetectable ctDNA status (p < 0.001):
On multivariate analysis, detectable ctDNA status was predictive of pN+ disease (OR 5.19, 95% CI 1.8-17.2, p = 0.003) and >= pT3a disease (OR 3.98, 95% CI 1.7-9.9, p = 0.002).
Dr. Sfakianos concluded his presentation discussing undetectable ctDNA status before radical cystectomy predicts improved outcomes with the following take-home points:
- Undetectable pre-cystectomy ctDNA predicts better pathological outcomes post-radical cystectomy
- Patients with undetectable pre-cystectomy status demonstrated recurrence-free survival, regardless of clinical stage or neoadjuvant treatment.
- Persistently undetectable ctDNA status is associated with favorable outcomes and may benefit from treatment de-es.collation
Presented by: John Sfakianos, MD, Icahn School of Medicine at Mount Sinai, New York, NY
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 International Bladder Cancer Network (IBCN) Annual Meeting, Bern, Switzerland, Thurs, Sept 19 – Sat, Sept 21, 2024