Mp77-04 Durability of Clinical Complete Response to Nac for Mibc With Adverse Pathologic Features

You have accessJournal of UrologyBladder Cancer: Invasive VI (MP77)1 May 2024MP77-04 DURABILITY OF CLINICAL COMPLETE RESPONSE TO NAC FOR MIBC WITH ADVERSE PATHOLOGIC FEATURES Rainjade Chung, Benjamin I. Joffe, Jane T. Kurtzman, Caroline Laplaca, Justin Ingram, Guarionex J. DeCastro, Christopher B. Anderson, James M. McKiernan, and Andrew T. Lenis Rainjade ChungRainjade Chung , Benjamin I. JoffeBenjamin I. Joffe , Jane T. KurtzmanJane T. Kurtzman , Caroline LaplacaCaroline Laplaca , Justin IngramJustin Ingram , Guarionex J. DeCastroGuarionex J. DeCastro , Christopher B. AndersonChristopher B. Anderson , James M. McKiernanJames M. McKiernan , and Andrew T. LenisAndrew T. Lenis View All Author Informationhttps://doi.org/10.1097/01.JU.0001009404.49693.12.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder sparing protocols for muscle invasive bladder cancer (MIBC) are becoming increasingly utilized due to emerging immunotherapies and novel biomarkers. The current standard of care is platinum-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). However, many patients refuse or are medically unfit for RC. Furthermore, 20%-30% of patients are pT0 at RC after NAC. Patients achieving a clinical complete response (cCR) to NAC who refused RC at our institution were placed on a surveillance cCR protocol. Here we report the impact of adverse pathologic features on outcomes in patients who achieve a cCR with NAC. METHODS: This was a retrospective review of patients on a cCR surveillance protocol with adverse features on initial MIBC pathology, defined as concomitant carcinoma in situ (CIS), secondary MIBC, lymphovascular invasion (LVI), variant histology (VH), and hydronephrosis. Patients received NAC for MIBC followed by cross-sectional imaging, cytology, and post-NAC maximal endoscopic resection. Patients were followed with cystoscopy, cytology, and imaging q3-4 months for 2 years, then q6 months for 2 years, and annually thereafter. Durable cCR was defined as no MIBC recurrence or metastasis. Outcomes of interest were durability of cCR and overall survival. RESULTS: Of 61 cCR patients, 18 (30%) had VH, 23 (38%) had CIS, 19 (31%) had LVI, 14 had (23%) secondary MIBC and 6 (10%) had hydronephrosis. Over a median follow up of 28 (10-59 months), 7 (11%) patients had MIBC recurrence, 11 (18%) developed metastasis, and 12 (20%) underwent cystectomy. Durability of cCR over the study period was achieved in >66% of patients in each adverse pathology group except for hydronephrosis, which had 50%. VH, LVI, and hydronephrosis had higher rates of MIBC recurrence compared to CIS and secondary MIBC. However, VH (p=0.49), CIS (p=0.85), LVI (p=0.54), secondary MIBC (p=0.77), and hydronephrosis (p=0.27) were not significantly more likely to develop MIBC recurrence or metastasis. CONCLUSIONS: Many patients who achieve cCR after NAC have durable responses despite adverse pathologic features. These data suggest that initial high-risk pathology may not affect cCR durability. Understanding who is at highest risk for recurrence or metastasis is important for counseling MIBC patients about bladder-sparing management. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1253 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rainjade Chung More articles by this author Benjamin I. Joffe More articles by this author Jane T. Kurtzman More articles by this author Caroline Laplaca More articles by this author Justin Ingram More articles by this author Guarionex J. DeCastro More articles by this author Christopher B. Anderson More articles by this author James M. McKiernan More articles by this author Andrew T. Lenis More articles by this author Expand All Advertisement PDF downloadLoading ...