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Predicting Pathologic Response to Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer

By: Cordi Craig, MS
Posted: Monday, January 3, 2022

For patients with non-metastatic muscle-invasive bladder cancer, the recommended treatment is neoadjuvant chemotherapy and radical cystectomy. However, it is challenging to predict whether patients who achieve a partial complete response to neoadjuvant chemotherapy would benefit from undergoing radical cystectomy or whether those patients would benefit more from close active surveillance instead. The prospective, multicenter PRE-PREVENCYS trial may help to identify patients who are candidates for bladder-sparing treatment because of a high preoperative response estimate. The report was published in BMC Cancer.

“Theoretically, a nonsurgical treatment strategy in those patients with a complete response after neoadjuvant chemotherapy will save up to 4% mortality, 22% of major morbidity and, potentially, reduces health-care costs,” Andre N. Vis, MD, PhD, of Amsterdam University Medical Centers, The Netherlands, and colleagues stated.

The researchers will assess 180 patients with muscle-invasive bladder cancer across 8 high-volume medical centers. The study will evaluate the pathologic stage in the radical cystectomy and its association with clinical response.

Patient responses to neoadjuvant chemotherapy will be assessed using CT scans. Blood and urine will be collected for biomarker analysis before and after neoadjuvant chemotherapy. The patients will undergo cystoscopy with bimanual examination and restaging transurethral resection of all visible cancerous lesions prior to receiving radical cystectomy surgery. Tissue from the diagnostic transurethral resection, the restaging transurethral resections, and the radical cystectomy specimen will be examined for urothelial cancer, and the DNA and RNA will be isolated for molecular analysis.

“If this PRE-PREVENCYS trial shows that residual disease after neoadjuvant chemotherapy can be determined reliably prior to radical cystectomy, a randomized controlled trial comparing neoadjuvant chemotherapy plus radical cystectomy versus neoadjuvant chemotherapy followed by a close active surveillance protocol will be conducted,” the research team concluded.

Disclosure: For full disclosures of the study authors, visit bmccancer.biomedcentral.com.



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