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Analysis of Neoadjuvant Immunotherapy and Chemotherapy for Muscle-Invasive Bladder Cancer in a National Registry
Journal article   Peer reviewed

Analysis of Neoadjuvant Immunotherapy and Chemotherapy for Muscle-Invasive Bladder Cancer in a National Registry

Matthew N. Klein, Oluwafolajimi Adesanya, Vince E. Xu, Olivia Gordon, Ryan M. Antar and Michael J. Whalen
Clinical genitourinary cancer, v 23(3), 102316
01 Jun 2025
DOI: https://doi.org/10.1016/j.clgc.2025.102316
PMID: 40044542
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Immune checkpoint inhibitors Pathologic response Radical cystectomy Urothelial cell carcinoma Oncology
•Older age, higher income and longer travel distance were associated with NIO use.•Treatment with NIO was less likely to achieve pR and pCR than treatment with NAC.•Similar overall survival was observed between NIO and NAC. Based on remarkable success in the metastatic/locally advanced space, Neoadjuvant Immunotherapy (NIO) is a promising novel treatment option for Muscle-Invasive Bladder Cancer (MIBC). Here, we assess factors associated with NIO and describe survival outcomes following NIO use in MIBC patients. The NCDB was used to identify 5,823 qualifying patients with a diagnosis of urothelial bladder cancer, T2-4N0-3M0 clinical stage and who received NIO or NAC prior to radical cystectomy between 2006 and 2019. NAC and NIO patient groups with similar clinical and demographic characteristics were defined using a 1:1 propensity score matching method. Mean age at diagnosis was significantly higher in NIO patients compared to NAC patients (70.22 ± 9.2 vs. 65.33 ± 9.1 years, P < .001). NAC administration correlated with an increased odds of pathologic complete response (pCR) compared to NIO in the unmatched (OR: 3.825, 95% CI: 1.972-7.417, P < .001) and matched (OR: 6.771, 95% CI: 2.624-17.473, P < .001) analyses. Finally, Cox proportional hazard model and Kaplan–Meier analysis revealed no difference in overall survival between NAC and NIO administration in the unmatched or matched analysis. In this study, older age, higher income and longer distance to facility were associated with the use of NIO compared to NAC. NIO administration was less effective at achieving pR and pCR compared to NAC. There was no observed difference in overall survival between patients that received NIO and those that received NAC. The ongoing phase III trials in this space should help to clarify the role of NIO. Neoadjuvant Immunotherapy (NIO) is a promising novel treatment option for Muscle-Invasive Bladder Cancer (MIBC). We compared 198 propensity matched MIBC patients that received neoadjuvant chemotherapy (NAC) or NIO retrospectively across clinical and oncologic outcomes. Treatment with NAC resulted in higher rates of complete pathologic response and similar overall survival compared to NIO. [Display omitted]

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Collaboration types
Domestic collaboration
Web of Science research areas
Oncology
Urology & Nephrology
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