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Analysis of neoadjuvant immunotherapy and chemotherapy for muscle-invasive bladder cancer in a national registry
Abstract   Peer reviewed

Analysis of neoadjuvant immunotherapy and chemotherapy for muscle-invasive bladder cancer in a national registry

Matthew Nicholas Klein, Vincent Eric Xu, Olivia French Gordon, Ryan Michael Antar and Michael Joseph Whalen
Journal of clinical oncology, v 42(4_suppl), 611
01 Feb 2024
DOI: https://doi.org/10.1200/JCO.2024.42.4_suppl.611

Abstract

283-183-138-226-11080 261-374 261-492-11294 261-566-148-2649 3 3 2 2
611 Background: Neoadjuvant immunotherapy (NIO) is an exciting new treatment option for muscle-invasive bladder cancer (MIBC). Early-phase trials are encouraging however increased evidence is needed to support its use over Neoadjuvant chemotherapy (NAC). In this study, we sought to assess factors associated with NIO use in MIBC and survival outcomes. Methods: The National Cancer Database was used to identify 8,267 patients between 2006 and 2019. Patients were included based on urothelial bladder cancer diagnosis, clinical staging (T2-4N0-3M0), and receipt of NIO or NAC prior to radical cystectomy. NAC and NIO patient groups with similar clinical and demographic characteristics were defined using a 1:1 propensity score matching method. Categorical and continuous were assessed with chi-square test and independent sample T-test, respectively. Survival outcomes were compared using Kaplan-Meier analyses. Results: Mean age at diagnosis was significantly higher in NIO patients (70.5 years, SD 8.93) compared to NAC patients (65.64 years, SD 8.99) (p<.001). NIO patients were associated with higher Charlson-Dayo scores (p=.028), high income (p=.027), treatment at an academic facility (p<.001), and at a facility greater than 30 miles away (p=.002) when compared to NAC patients. In the matched analysis, these characteristics were all similar. NAC use was associated with increased rates of T down-staging to pT0-1 compared to NIO (47/118, 39.8% vs 20/109, 18.3%; p<0.001). Conversely, NIO use was associated with increased rates of T up-staging to pT3-4 compared to NAC (38/109, 34.9% vs 23/118, 19.5%; p=0.009). Kaplan-Meier analysis demonstrated no difference in overall survival when comparing patients who received NIO and NAC (p=.477). Conclusions: In this study use of NIO was associated with older and more comorbid patients compared to NAC. We found NIO less effective at achieving pathologic down-staging than NAC. Furthermore, increased rates of pathologic up-staging were observed with NIO use compared to NAC. These findings suggest the clinical benefit of neoadjuvant immunotherapy remains unclear. [Table: see text]

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