Neoadjuvant vs. Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database

G. Del Bene, F. Calabro, D. Giannarelli, E. R. Plimack, L. C. Harshman, E. Y. Yu, S. J. Crabb, S. K. Pal, A. S. Alva, T. Powles, U. De Giorgi, N. Agarwal, A. Bamias, S. Ladoire, A. Necchi, U. N. Vaishampayan, G. Niegisch, J. Bellmunt, J. Baniel, M. D. GalskyC. N. Sternberg

Research output: Contribution to journalArticle

Abstract

Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36 to 48% for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy (AC) in MIBC. Methods: Data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival (OS), cancer specific survival (CSS), and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier method were compared for MIBC by log-rank test. All patients in this analysis received either NC or AC. Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median DFS was 34.6 months (95% CI:25.3-43.9) for NC vs. 24.9 months (95% CI: 19.4-30.5) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.78, 95% CI: 0.63-0.96, P = 0.02). There were no significant differences in terms of CSS (HR: 1.06, 95% CI: 0.79-1.43, P: 0.70), and OS (HR: 1.08, 95% CI: 0.83-1.39, P = 0.57). Conclusions: This study demonstrates superiority in DFS for NC compared to AC. The positive prognostic impact of complete pathological response to NC was confirmed.
Original languageEnglish
Pages (from-to)463
Number of pages1
JournalFrontiers in Oncology
Volume8
DOIs
Publication statusPublished - Nov 19 2018

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Adjuvant Chemotherapy
Urinary Bladder Neoplasms
Databases
Muscles
Survival
Disease-Free Survival
Neoplasms
Neoadjuvant Therapy
Risk Reduction Behavior
Disease Progression
Survival Rate
Retrospective Studies
Drug Therapy

Keywords

  • RISC data base
  • adjuvant chemotherapy
  • locally advanced bladder cancer
  • muscle invasive bladder cancer
  • neoadjuvant chemotherapy

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Neoadjuvant vs. Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database. / Bene, G. Del; Calabro, F.; Giannarelli, D.; Plimack, E. R.; Harshman, L. C.; Yu, E. Y.; Crabb, S. J.; Pal, S. K.; Alva, A. S.; Powles, T.; Giorgi, U. De; Agarwal, N.; Bamias, A.; Ladoire, S.; Necchi, A.; Vaishampayan, U. N.; Niegisch, G.; Bellmunt, J.; Baniel, J.; Galsky, M. D.; Sternberg, C. N.

In: Frontiers in Oncology, Vol. 8, 19.11.2018, p. 463.

Research output: Contribution to journalArticle

Bene, GD, Calabro, F, Giannarelli, D, Plimack, ER, Harshman, LC, Yu, EY, Crabb, SJ, Pal, SK, Alva, AS, Powles, T, Giorgi, UD, Agarwal, N, Bamias, A, Ladoire, S, Necchi, A, Vaishampayan, UN, Niegisch, G, Bellmunt, J, Baniel, J, Galsky, MD & Sternberg, CN 2018, 'Neoadjuvant vs. Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database', Frontiers in Oncology, vol. 8, pp. 463. https://doi.org/10.3389/fonc.2018.00463 [doi]
Bene, G. Del ; Calabro, F. ; Giannarelli, D. ; Plimack, E. R. ; Harshman, L. C. ; Yu, E. Y. ; Crabb, S. J. ; Pal, S. K. ; Alva, A. S. ; Powles, T. ; Giorgi, U. De ; Agarwal, N. ; Bamias, A. ; Ladoire, S. ; Necchi, A. ; Vaishampayan, U. N. ; Niegisch, G. ; Bellmunt, J. ; Baniel, J. ; Galsky, M. D. ; Sternberg, C. N. / Neoadjuvant vs. Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database. In: Frontiers in Oncology. 2018 ; Vol. 8. pp. 463.
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abstract = "Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36 to 48{\%} for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy (AC) in MIBC. Methods: Data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival (OS), cancer specific survival (CSS), and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier method were compared for MIBC by log-rank test. All patients in this analysis received either NC or AC. Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median DFS was 34.6 months (95{\%} CI:25.3-43.9) for NC vs. 24.9 months (95{\%} CI: 19.4-30.5) with AC, with a reduction in the risk of disease progression of 21{\%} in favor of NC (HR: 0.78, 95{\%} CI: 0.63-0.96, P = 0.02). There were no significant differences in terms of CSS (HR: 1.06, 95{\%} CI: 0.79-1.43, P: 0.70), and OS (HR: 1.08, 95{\%} CI: 0.83-1.39, P = 0.57). Conclusions: This study demonstrates superiority in DFS for NC compared to AC. The positive prognostic impact of complete pathological response to NC was confirmed.",
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TY - JOUR

T1 - Neoadjuvant vs. Adjuvant Chemotherapy in Muscle Invasive Bladder Cancer (MIBC): Analysis From the RISC Database

AU - Bene, G. Del

AU - Calabro, F.

AU - Giannarelli, D.

AU - Plimack, E. R.

AU - Harshman, L. C.

AU - Yu, E. Y.

AU - Crabb, S. J.

AU - Pal, S. K.

AU - Alva, A. S.

AU - Powles, T.

AU - Giorgi, U. De

AU - Agarwal, N.

AU - Bamias, A.

AU - Ladoire, S.

AU - Necchi, A.

AU - Vaishampayan, U. N.

AU - Niegisch, G.

AU - Bellmunt, J.

AU - Baniel, J.

AU - Galsky, M. D.

AU - Sternberg, C. N.

N1 - LR: 20181207; JID: 101568867; OTO: NOTNLM; 2018/08/06 00:00 [received]; 2018/10/02 00:00 [accepted]; 2018/12/05 06:00 [entrez]; 2018/12/05 06:00 [pubmed]; 2018/12/05 06:01 [medline]; epublish

PY - 2018/11/19

Y1 - 2018/11/19

N2 - Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36 to 48% for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy (AC) in MIBC. Methods: Data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival (OS), cancer specific survival (CSS), and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier method were compared for MIBC by log-rank test. All patients in this analysis received either NC or AC. Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median DFS was 34.6 months (95% CI:25.3-43.9) for NC vs. 24.9 months (95% CI: 19.4-30.5) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.78, 95% CI: 0.63-0.96, P = 0.02). There were no significant differences in terms of CSS (HR: 1.06, 95% CI: 0.79-1.43, P: 0.70), and OS (HR: 1.08, 95% CI: 0.83-1.39, P = 0.57). Conclusions: This study demonstrates superiority in DFS for NC compared to AC. The positive prognostic impact of complete pathological response to NC was confirmed.

AB - Background: MIBC is an aggressive disease, with 5-year survival rates ranging from 36 to 48% for p T3/p T4/p N+tumors. Perioperative treatment can improve overall survival, with more robust evidence in favor of neoadjuvant chemotherapy. Few randomized studies have compared neoadjuvant and adjuvant therapy in bladder cancer. Consequently, it has been difficult to establish the benefit of adjuvant chemotherapy (AC) in MIBC. Methods: Data from patients with muscle invasive bladder cancer (>pT2) collected from 2005 to 2012 within the RISC data base (Retrospective International Study of Cancers of the Urothelial Tract) were evaluated. Overall survival (OS), cancer specific survival (CSS), and disease-free survival (DFS) between NC and AC generated using the Kaplan-Meier method were compared for MIBC by log-rank test. All patients in this analysis received either NC or AC. Results: A total of 656 patients with MIBC (325 treated with AC and 331 with NC) were analyzed. The median DFS was 34.6 months (95% CI:25.3-43.9) for NC vs. 24.9 months (95% CI: 19.4-30.5) with AC, with a reduction in the risk of disease progression of 21% in favor of NC (HR: 0.78, 95% CI: 0.63-0.96, P = 0.02). There were no significant differences in terms of CSS (HR: 1.06, 95% CI: 0.79-1.43, P: 0.70), and OS (HR: 1.08, 95% CI: 0.83-1.39, P = 0.57). Conclusions: This study demonstrates superiority in DFS for NC compared to AC. The positive prognostic impact of complete pathological response to NC was confirmed.

KW - RISC data base

KW - adjuvant chemotherapy

KW - locally advanced bladder cancer

KW - muscle invasive bladder cancer

KW - neoadjuvant chemotherapy

U2 - 10.3389/fonc.2018.00463 [doi]

DO - 10.3389/fonc.2018.00463 [doi]

M3 - Article

VL - 8

SP - 463

JO - Frontiers in Oncology

JF - Frontiers in Oncology

SN - 2234-943X

ER -