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Thomas Flaig, MD


Is Neoadjuvant Standard of Care for Muscle-Invasive Bladder Cancer Appropriate for Older Patients?

By: Kayci Reyer
Posted: Monday, August 29, 2022

Age may not be a relevant factor when choosing appropriate neoadjuvant therapy for patients with muscle-invasive bladder cancer, according to research presented in European Urology Oncology. Concerns about potential toxicity often prevent elderly patients from receiving accelerated methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), the standard-of-care treatment.

“Careful selection based on clinical variables, and not age, should identify patients able to receive neoadjuvant chemotherapy,” concluded Matthew Zibelman, MD, of Fox Chase Cancer Center in Philadelphia, and colleagues. “Further studies should elicit additional disease-specific features that could be used to predict neoadjuvant chemotherapy response and, thus, limit the risk of toxic chemotherapy exposure for elderly patients who may be nonresponders.”

The retrospective study included 186 patients with muscle-invasive bladder cancer who underwent neoadjuvant treatment at Fox Chase Cancer Center between January 2002 and December 2018. Eligible patients received accelerated MVAC treatment prior to planned cystectomy. Patients were stratified into three age-based groups: younger than 65, 65 to 74 years, and 75 and older. Renal function, often associated with perceived frailty of elderly patients, was assessed at baseline and at predetermined intervals following treatment.

Treatment efficacy did not differ significantly across age groups, the study authors reported. Though full safety data were unavailable, factors related to tolerability, such as dose reductions, treatment interruptions, and adverse events, were comparable across groups, as was the time to surgery. Older age was associated with substantially worse baseline renal function and greater decline in creatinine clearance.

“Elderly patients experienced a greater decline in kidney function with treatment but not more complications than younger patients and tolerated therapy with minimal dose changes, resulting in benefit regardless of age,” concluded the authors.

Disclosure: The study authors reported no conflicts of interest.

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