MP47-04 REFINING SELECTION CRITERIA FOR NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: COMBINING CLINICAL RISK FEATURES AND INTRINSIC MOLECULAR SUBTYPES

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2018MP47-04 REFINING SELECTION CRITERIA FOR NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: COMBINING CLINICAL RISK FEATURES AND INTRINSIC MOLECULAR SUBTYPES Jonathan Duplisea, Michael Metcalfe, Debasish Sundi, Jed Ferguson, Roger Li, Shanna Pretzsch, Ashish Kamat, Neema Navai, Jay Shah, Jolanta Bondaruk, Bogdan Czerniak, Woonyoung Choi, David McConkey, Peter Black, and Colin Dinney Jonathan DupliseaJonathan Duplisea More articles by this author , Michael MetcalfeMichael Metcalfe More articles by this author , Debasish SundiDebasish Sundi More articles by this author , Jed FergusonJed Ferguson More articles by this author , Roger LiRoger Li More articles by this author , Shanna PretzschShanna Pretzsch More articles by this author , Ashish KamatAshish Kamat More articles by this author , Neema NavaiNeema Navai More articles by this author , Jay ShahJay Shah More articles by this author , Jolanta BondarukJolanta Bondaruk More articles by this author , Bogdan CzerniakBogdan Czerniak More articles by this author , Woonyoung ChoiWoonyoung Choi More articles by this author , David McConkeyDavid McConkey More articles by this author , Peter BlackPeter Black More articles by this author , and Colin DinneyColin Dinney More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1483AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clinical and pathologic high-risk (HR) features have been identified to select patients with muscle-invasive bladder cancer (MIBC) for neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC). Recently, genomic studies have identified intrinsic basal, p53-like, and luminal molecular subtypes of MIBC. The basal subtype is associated with a worse prognosis when treated by RC alone, but has a favorable response to NAC. We sought to study the value of NAC in patients with basal tumors, and to confirm that subtype predicts response to chemotherapy irrespective of clinical risk grouping. METHODS We identified patients with MIBC who underwent RC with or without NAC at two institutions. Patients were considered HR based on the presence of hydroureteronephrosis, cT3b-T4a disease, and/or histological evidence of lymphovascular invasion, micropapillary or neuroendocrine features on transurethral resection (TURBT). Low-risk (LR) tumors did not possess these features. Whole-genome analysis was performed on TURBT specimens classifying them into basal, luminal or p53-like subtypes. Overall survival (OS) outcomes were compared for each subtype and clinical risk criteria. RESULTS 165 patients were included in our analysis. 52 (32%) were LR and 113 (68%) HR; 99 (60%) patients received NAC and of these, 82 (83%) and 17 (17%) were HR and LR respectively. 49 (30%) of patients had basal tumors. A significant survival benefit with NAC was seen in patients with basal tumors in both HR and LR cohorts (p<0.0001) Fig 1. There was no statistically significant difference in benefit for NAC in patients with either luminal (p=0.2374), or p53-like subtype tumors (0.4134). CONCLUSIONS NAC chemotherapy appears to benefit patients with basal tumors regardless of their clinical risk stratification. Once validated, the risk criteria used to identify HR tumors may include basal tumors, especially since their OS is prolonged after NAC. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e616 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jonathan Duplisea More articles by this author Michael Metcalfe More articles by this author Debasish Sundi More articles by this author Jed Ferguson More articles by this author Roger Li More articles by this author Shanna Pretzsch More articles by this author Ashish Kamat More articles by this author Neema Navai More articles by this author Jay Shah More articles by this author Jolanta Bondaruk More articles by this author Bogdan Czerniak More articles by this author Woonyoung Choi More articles by this author David McConkey More articles by this author Peter Black More articles by this author Colin Dinney More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...