PD44-06 CHEMOTHERAPY VS IMMUNOTHERAPY AS NEOADJUVANT THERAPIES IN CISPLATIN-ELIGIBLE PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD44-06 CHEMOTHERAPY VS IMMUNOTHERAPY AS NEOADJUVANT THERAPIES IN CISPLATIN-ELIGIBLE PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER Luigi Nocera, Marco Bandini, Giuseppe Basile, Marco Moschini, Shreyas Naidu, Kyle Rose, Roger Li, Philippe Spiess, and Andrea Necchi Luigi NoceraLuigi Nocera More articles by this author , Marco BandiniMarco Bandini More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Shreyas NaiduShreyas Naidu More articles by this author , Kyle RoseKyle Rose More articles by this author , Roger LiRoger Li More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , and Andrea NecchiAndrea Necchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003354.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chemotherapy has represented one of the cornerstone of the treatment landscape of muscle invasive bladder cancer (MIBC), due to its improvement in survival outcomes. Recently, also immunotherapy also showed to improve both pathological response, as well as survival outcomes. However, no comparison has ever been performed between the two neoadjuvant treatments. We aimed to compare cisplatinum-based chemotherapy and pembrolizumab in MIBC patients undergoing radical cystectomy (RC). METHODS: We retrospectively identified patients with MIBC and treated with RC after neoadjuvant treatment with either cisplatin or pembrolizumab in two tertiary referral centers. Cisplatinum-eligibility represented an inclusion criterion. Conversely, clinical node positive disease and adjuvant chemotherapy administration were exclusion criteria. The endpoint of the analyses was recurrence-free survival (RFS). Statistical analyses consisted of Kaplan-Meier (KM) curves before and after inverse-probability treatment weighting (IPTW), adjusting for age, gender, pathological stage, concomitant CIS and variant histology (VH). RESULTS: Of all 346 patients, median age was 67 years (IQR 60-73) and the majority of patients were male (80.3%). The majority of patients harbored a pT0N0 disease (30.3%) at RC pathology followed by pT2-4N0 (29.5%), pTanyN1-3 (20.5%) and pT1-a-isN0 (19.6%). Moreover, 113 patients (32.6%) exhibited concomitants CIS, while 255 patients (73.7%), 27 patients (7.8%) and 64 patients (18.5%) showed respectively presence of pure/mixed urothelial carcinoma, pure VH and other histology. Overall, 70 patients (20.2%) experienced recurrence (33.9% pelvic vs 66.1% distant) after a median follow-up of 24 months (12-39). KM showed a 24-months RFS of 76.9 vs 86.6% for cisplatinum-based chemotherapy versus pembrolizumab (p<0.01). After IPTW for age, gender, pathological stage, concomitant CIS and VH, KM showed 76.8 vs 93.2% for cisplatinum-based chemotherapy versus pembrolizumab (p=0.01). CONCLUSIONS: We compared RFS after cisplatinum chemotherapy vs pembrolizumab as neoadjuvant treatment in MIBC undergoing RC. Our findings suggest a potentially higher benefit of pembrolizumab, that was confirmed after adjustment for confounders. Source of Funding: NONE © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1126 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luigi Nocera More articles by this author Marco Bandini More articles by this author Giuseppe Basile More articles by this author Marco Moschini More articles by this author Shreyas Naidu More articles by this author Kyle Rose More articles by this author Roger Li More articles by this author Philippe Spiess More articles by this author Andrea Necchi More articles by this author Expand All Advertisement PDF downloadLoading ...