Bladder Cancer Coverage from Every Angle

ASCO 2021: Chemotherapy Prior to Cystectomy for Older Patients With Muscle-Invasive Bladder Cancer

By: Cordi Craig, MS
Posted: Friday, July 2, 2021

Although many patients with muscle-invasive bladder cancer benefit from neoadjuvant chemotherapy prior to radical cystectomy, clinicians may not offer the treatment to elderly patients due to a concern regarding physiologic reserve and postoperative complications. However, a population-based study presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 4536) reported that neoadjuvant chemotherapy did not appear to impair perioperative outcomes or mortality rates among elderly patients undergoing radical cystectomy.

“Advanced age in properly selected patients should not preclude offering neoadjuvant chemotherapy prior to radical cystectomy,” Natasza Posielski, MD, of Virginia Mason Medical Center, Seattle, and colleagues concluded.

Using the National Cancer Database, the researchers identified nearly 71,000 patients with non-metastatic muscle-invasive bladder cancer between 2006 to 2017. The study team evaluated the use of different treatments including radical cystectomy, radical cystectomy plus adjuvant chemotherapy, radical cystectomy plus neoadjuvant chemotherapy, chemoradiation therapy, and no treatment among all age groups. A separate analysis evaluated patients aged 70 and older undergoing radical cystectomy.

The use of radical cystectomy with neoadjuvant chemotherapy was significantly lower in patients older than 70 (P < .001). Patients who received radical cystectomy with neoadjuvant chemotherapy tended to be younger, have private insurance, higher high school completion rates and median income, and lived a shorter distance to the hospital compared with those who did not receive neoadjuvant chemotherapy. However, among elderly patients undergoing radical cystectomy, the use of neoadjuvant chemotherapy was associated with a shorter length of hospital stay (P < .001), decreased 30-day readmission (P = .003), lower 30- and 90-day mortality rates (P = .01 and P = .003, respectively), and better overall survival (P < .001) than patients who did not receive the treatment. Of note, neoadjuvant chemotherapy was an independent predictor of shorter length of stay, lower 30- and 90-day mortality, and improved overall survival.

Disclosure: The study authors reported no conflicts of interest.

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