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1. A longitudinal study evaluating interim assessment of neoadjuvant chemotherapy for bladder cancer

Author

Furrer, MA, Papa, N, Luetolf, S, Roth, B, Cumberbatch, M, Vartolomei, MD, Thomas, BC, Thoeny, HC, Seiler, R, Thalmann, GN, Kiss, B, Furrer, MA, Papa, N, Luetolf, S, Roth, B, Cumberbatch, M, Vartolomei, MD, Thomas, BC, Thoeny, HC, Seiler, R, Thalmann, GN, and Kiss, B

Abstract

OBJECTIVES: To evaluate the usefulness of radiological re-staging after two and four cycles of neoadjuvant chemotherapy (NAC), the impact of re-staging on further patient management, and the correlation between clinical and final pathological tumour stage at radical cystectomy (RC). PATIENTS AND METHODS: We conducted a longitudinal, single-centre, cohort study of prospectively collected consecutive patients who underwent NAC and RC for urothelial muscle-invasive bladder cancer between July 2001 and December 2017. Patients underwent repeated computed tomography scans for re-staging after two cycles of NAC and after completion of NAC before RC. RESULTS: Of 180 patients, 110 had ≥four cycles of NAC and had complete imaging available. In the entire cohort, further patient management was only changed in 2/180 patients (1.1%) after two cycles of NAC based on radiological findings. Patients who were stable after two cycles but then downstaged after at least four cycles of NAC had a similarly lowered risk of death (hazard ratio [HR] 0.53). Only one patient downstaged after two cycles was subsequently upstaged after four cycles. Clinical downstaging was observed in 51 patients (46%), 55 patients (50%) had no change in clinical stage and four patients (3.6%) were clinically upstaged. Patients clinically downstaged after four cycles of NAC had a lower risk of death (HR 0.49, 95% confidence interval 0.25-0.94; P = 0.033) compared to those with no change or upstaged after completion of NAC. CONCLUSIONS: Re-staging of muscle-invasive bladder cancer after two cycles of NAC offers little additional information, rarely changes patient management, and may therefore be omitted, whereas re-staging after completion of NAC by CT is a strong predictor of overall survival.

Published
2022

2. EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort Under the Auspices of the EAU-ESMO Guidelines Committees

Author

Witjes, JA, Babjuk, M, Bellmunt, J, Bruins, HM, De Reijke, TM, De Santis, M, Gillessen, S, James, N, Maclennan, S, Palou, J, Powles, T, Ribal, MJ, Shariat, SF, Van der Kwast, T, Xylinas, E, Agarwal, N, Arends, T, Bamias, A, Birtle, A, Black, PC, Bochner, BH, Bolla, M, Boormans, JL, Bossi, A, Briganti, A, Brummelhuis, I, Burger, M, Castellano, D, Cathomas, R, Chiti, A, Choudhury, A, Comperat, E, Crabb, S, Culine, S, De Bari, B, De Blok, W, De Visschere, PJL, Decaestecker, K, Dimitropoulos, K, Dominguez-Escrig, JL, Fanti, S, Fonteyne, V, Frydenberg, M, Futterer, JJ, Gakis, G, Geavlete, B, Gontero, P, Grubmueller, B, Hafeez, S, Hansel, DE, Hartmann, A, Hayne, D, Henry, AM, Hernandez, V, Herr, H, Herrmann, K, Hoskin, P, Huguet, J, Jereczek-Fossa, BA, Jones, R, Kamat, AM, Khoo, V, Kiltie, AE, Krege, S, Ladoire, S, Lara, PC, Leliveld, A, Linares-Espinos, E, Logager, V, Lorch, A, Loriot, Y, Meijer, R, Mir, MC, Moschini, M, Mostafid, H, Mueller, A-C, Mueller, CR, N'Dow, J, Necchi, A, Neuzillet, Y, Oddens, JR, Oldenburg, J, Osanto, S, Oyen, WJG, Pacheco-Figueiredo, L, Pappot, H, Patel, M, Pieters, BR, Plass, K, Remzi, M, Retz, M, Richenberg, J, Rink, M, Roghmann, F, Rosenberg, JE, Roupret, M, Rouviere, O, Salembier, C, Salminen, A, Sargos, P, Sengupta, S, Sherif, A, Smeenk, RJ, Smits, A, Stenzl, A, Thalmann, GN, Tombal, B, Turkbey, B, Lauridsen, SV, Valdagni, R, Van der Heijden, AG, Van Poppel, H, Vartolomei, MD, Veskimae, E, Vilaseca, A, Rivera, FAV, Wiegel, T, Wiklund, P, Williams, A, Zigeuner, R, Horwich, A, Witjes, JA, Babjuk, M, Bellmunt, J, Bruins, HM, De Reijke, TM, De Santis, M, Gillessen, S, James, N, Maclennan, S, Palou, J, Powles, T, Ribal, MJ, Shariat, SF, Van der Kwast, T, Xylinas, E, Agarwal, N, Arends, T, Bamias, A, Birtle, A, Black, PC, Bochner, BH, Bolla, M, Boormans, JL, Bossi, A, Briganti, A, Brummelhuis, I, Burger, M, Castellano, D, Cathomas, R, Chiti, A, Choudhury, A, Comperat, E, Crabb, S, Culine, S, De Bari, B, De Blok, W, De Visschere, PJL, Decaestecker, K, Dimitropoulos, K, Dominguez-Escrig, JL, Fanti, S, Fonteyne, V, Frydenberg, M, Futterer, JJ, Gakis, G, Geavlete, B, Gontero, P, Grubmueller, B, Hafeez, S, Hansel, DE, Hartmann, A, Hayne, D, Henry, AM, Hernandez, V, Herr, H, Herrmann, K, Hoskin, P, Huguet, J, Jereczek-Fossa, BA, Jones, R, Kamat, AM, Khoo, V, Kiltie, AE, Krege, S, Ladoire, S, Lara, PC, Leliveld, A, Linares-Espinos, E, Logager, V, Lorch, A, Loriot, Y, Meijer, R, Mir, MC, Moschini, M, Mostafid, H, Mueller, A-C, Mueller, CR, N'Dow, J, Necchi, A, Neuzillet, Y, Oddens, JR, Oldenburg, J, Osanto, S, Oyen, WJG, Pacheco-Figueiredo, L, Pappot, H, Patel, M, Pieters, BR, Plass, K, Remzi, M, Retz, M, Richenberg, J, Rink, M, Roghmann, F, Rosenberg, JE, Roupret, M, Rouviere, O, Salembier, C, Salminen, A, Sargos, P, Sengupta, S, Sherif, A, Smeenk, RJ, Smits, A, Stenzl, A, Thalmann, GN, Tombal, B, Turkbey, B, Lauridsen, SV, Valdagni, R, Van der Heijden, AG, Van Poppel, H, Vartolomei, MD, Veskimae, E, Vilaseca, A, Rivera, FAV, Wiegel, T, Wiklund, P, Williams, A, Zigeuner, R, and Horwich, A

Abstract

BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference. SETTING: Online Delphi survey and consensus conference. PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS: These consensus stateme

Published
2020

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