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Dr. Garje compares outcomes in sacromatoid versus classic urothelial carcinoma


"There was a striking decreased survival for patients who had sarcomatoid histology compared to the ones who had the classic variant urothelial histology," says Rohan Garje, MD.

In this video, Rohan Garje, MD, highlights findings from the study, “Survival outcomes of sarcomatoid versus classic urothelial carcinoma of bladder,” which was presented at the 2023 ASCO Annual Meeting in Chicago, Illinois. Garje is the chief of GU medical oncology at Miami Cancer Institute, Baptist Health South Florida.

Video Transcript:

We are excited to present our recent research work using NCDB database, which is called National Cancer Database. And we worked on a cohort of patients with bladder cancer with sarcomatoid histology. As you know, bladder cancer is fairly common, in our top 10 cancers in men and women. The most common variant is called classic variant urothelial cancer, which is most of the cases and most of the research is in that. But at the same time, there are a fraction of patients who have this variant histology called sarcomatoid, where the cancer looks different compared to what the traditional urothelial cancer looks like. The big issues with those kinds of variant histology is there is no standard of care. So any of the clinical trials, which are being run right now, they tend to exclude patients who have predominant sarcomatoid histology. My big goal was to make sure to have guidance and in terms of treatment, what works best. What we did in the study was we utilized something called the National Cancer database, we identified about 400, plus patients with this particular histology, and looked at how they present in terms of the diagnosis and selected patients who had muscle invasive bladder cancer with regional lymph node involvement, and then compared them with patients who have classic variant urothelial carcinoma.

Having said that, what we saw was there was a striking decreased survival for patients who had sarcomatoid histology compared to the ones who had the classic variant urothelial histology. That is obviously a big important finding, because it's a rare cancer and also has inferior survival. Now, the second important finding in the study was the patients who received perioperative chemotherapy, predominantly neoadjuvant chemotherapy, and the fraction of patients who got adjuvant chemotherapy, in addition to surgery actually had better survival than the patients who had surgery alone. So as a comparison, in classic variant urothelial cancer, the standard right now is to offer them cisplatin based chemotherapy, followed by surgery, but there is no such standard for pure sarcomatoid. So, in the study, we did notice that even in this variant, if they get neoadjuvant, and sometimes adjuvant chemotherapy, they actually had better responses and their overall survival was better. So, this information is very critical for practicing clinicians where there is not much research or clinical trial driven guidance that these rare histologies do benefit with chemotherapy and can have better survival.

This transcription has been edited for clarity.

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