Patterns of chemotherapy use for muscle-invasive bladder cancer at a single tertiary institution in Australia.

Abstract

INTRODUCTION AND OBJECTIVES: Although randomised studies demonstrate a survival benefit with neoadjuvant chemotherapy (NAC) prior to cystectomy (RC) in muscle-invasive bladder cancer (MIBC), concerns remain about delay in surgical treatment and progression in non-responders. There is no Australian data on patterns of NAC use prior to cystectomy. Our aim was to evaluate the patterns of NAC and adjuvant chemotherapy (AC) use for MIBC in a single tertiary centre. METHOD(S): Patients who had a histologic diagnosis of >= pT2 urothelial carcinoma and subsequent RC at our centre between 2011 and 2021 were retrospectively identified. Patient, chemotherapy and tumour data were collected and analysed. RESULT(S): Of a total of 120 patients, 70 had a RC for pT2+ bladder cancer. Of these patients, six (8.6%) received NAC prior to RC, 20 (28.6%) received AC and two (2.9%) received adjuvant radiotherapy. 19 patients (27.1%) developed metastases and 20 (28.6%) died at a median followup of 20.8 (IQR 7.3- 53.9) months. Of the patients who received NAC, the median time from diagnosis to RC was 3.8 months (IQR 2.1 -4.6). Of these, four (66.7%) had downstaging to pT1 disease at RC, one (16.7%) developed metastases and two (33%) died on follow-up. The median time from cystectomy to AC was 1.6 months and Gemcitabine and Cisplatin were most frequently used (55%). 26 patients out of 46 (56.5%) who were eligible for AC did not receive chemotherapy with the most common reason being patients being unfit (10.9%) and patients declining treatment (10.9%). Of the 20 patients who received AC, five (25%) developed metastases and six (30%) died following AC. There was no difference in progression-free survival or overall survival between those who received NAC and AC. CONCLUSION(S): Majority of patients undergoing RC received AC compared to NAC, reflecting real-world practice. Further studies on the determinants of real-world selection for NAC are needed.