Bladder Cancer Coverage from Every Angle

Can Circulating Tumor Cells Predict Need for Neoadjuvant Chemotherapy in Bladder Cancer?

By: Julia Fiederlein
Posted: Tuesday, July 13, 2021

The presence of circulating tumor cells is an established prognostic marker in muscle-invasive bladder cancer. Nick Beije, MD, PhD, of Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues hypothesized that the absence of these cells may help to identify patients with a favorable prognosis who may not require neoadjuvant chemotherapy. The results of the CirGuidance study, which were presented during the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 4523), suggested that circulating tumor cell enumeration at the time of diagnosis may aid in the decision to prescribe neoadjuvant chemotherapy as a criterion in addition to clinical characteristics.

“The 2-year overall survival in the circulating tumor cell–negative group did not meet the prespecified criterion for trial success,” the investigators commented. “However, given the trial population’s advanced age and high rate of non–cancer-related mortality, the benefit of neoadjuvant chemotherapy is likely to be limited in circulating tumor cell–negative patients.”

Adults with muscle-invasive urothelial carcinoma of the bladder who were eligible for radical cystectomy were enrolled. Patients without detectable circulating tumor cells (n = 203) underwent surgery without neoadjuvant chemotherapy; those with detectable circulating tumor cells (n = 70) were advised to undergo neoadjuvant chemotherapy prior to surgery.

The 2-year overall survival rates in patients with and without detectable circulating tumor cells were 58.2% and 69.5%, respectively. Patients with detectable circulating tumor cells seemed to experience higher rates of cancer-related mortality (hazard ratio = 1.61; P = .03) and disease relapse (hazard ratio = 1.87; P = .001) than those without. Based on the results of explorative analyses, patients with detectable circulating tumor cells who received neoadjuvant chemotherapy experienced a higher 2-year overall survival rate than those who did not undergo this treatment (74.8% vs. 52.0%).

Disclosure: Dr. Beije reported no conflicts of interest. For full disclosures of the other study authors, visit

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