Dr. Roy on neoadjuvant chemo in sarcomatoid bladder cancer

Arya Mariam Roy, MBBS, an oncology/hematology fellow at the Roswell Park Comprehensive Cancer Center, discusses the effect of neoadjuvant chemotherapy on overall survival in patients with sarcomatoid bladder cancer. Roy presented an abstract on these findings at the 2023 ASCO Genitourinary Cancers Symposium (abstract 530).

Transcript

The prevalence of sarcomatoid bladder cancer is only 0.2% to 0.3%. I think in my clinical practice, I might have seen maybe like 2 to 3 sarcomatoid bladder cancer patients in 1 year. So the mainstay of treatment, we don't know that for sarcomatoid bladder cancer, because what we have is actually from urothelial cancer, and most of the time, we try to extrapolate whatever treatment options that we have in the urothelial bladder cancer to the sarcomatoid bladder cancer patients. But that may or may not work sometimes because we don't have enough data in the setting.

What we generally do is we do radical cystectomy. And after that, we tend to give adjuvant chemotherapy to some patients who we think are high-risk patients, especially muscle invasive bladder cancer patients. So as we do not have any consensus regarding the management ofsarcomatoid bladder cancer, I wanted to study about the clinical outcomes in bladder cancer, especially with the neoadjuvant chemotherapy because we do not have any data at all in the neoadjuvant space in sarcomatoid bladder cancer.

We used the NCDB database because NCDB covers almost 70% of the US population. So that will give us a good representation of the sarcomatoid patients in the whole United States. So we looked into the NCDB database, and we actually selected patients who have predominantly sarcomatoid variant of bladder cancer. We then divided the cohort population into 2. We divided them to 1 cohort, which was actually the patients who received the neoadjuvant chemotherapy and the other cohort was the patients who did not receive the neoadjuvant chemotherapy.

And we found out that the patients who received the neoadjuvant chemotherapy had more pathological downstaging after the radical cystectomy when compared to the other group. And then we wanted to see, “Okay, we they have good pathological response, what about the survival?” So, regarding the survival statistics, we found out that the patients who received the neoadjuvant chemotherapy had significantly longer survival when compared to the other group who did not receive neoadjuvant chemotherapy. In the group that did not receive any urgent chemotherapy, the survival was 20 months. And in the group which received neoadjuvant chemotherapy, the survival was double that at about 40 months, which was very significant, and which was actually very interesting to know, because we didn't know how the patients are responding to neoadjuvant treatment.

We then decided to adjust the whole analysis to account for all the confounding factors that can impact the study results, such as the age of the patients, the race of the patients, the gender of the patients, and their socioeconomic status. We also adjusted for the facilities where they are observed and receiving this treatment because the treatments from a comprehensive cancer center might be very different when compared to those from a community center. So we adjusted for all these confounders and even after that, we found that the survival statistics were actually better in the neoadjuvant group compared to the non-neoadjuvant group, and both the pathological downstaging and the receipt of neoadjuvant chemotherapy were independent predictors of survival in sarcomatoid bladder cancer.

The transcript has been edited for clarity.