Presentation Authors: Ahmad El-Arabi*, Kansas City, KS, Garth Sherman, Kansas City, MO, Jeffrey Holzbeierlein, Eugene Lee, Elizabeth Wulff-Burchfield, Kansas City, KS
Introduction: We aimed to determine the etiology of delays in the start, completion and non-completion of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) and the impact of these delays on survival.
Methods: We performed a retrospective review of patients with MIBC who received NAC followed by radical cystectomy between 2008 and 2016. Clinicopathologic characteristics including timing of initiation and termination of NAC, chemotherapy regimen and reasons for delay or discontinuation of NAC were analyzed retrospectively using an institutional database. Kaplan-Meier estimates were used to create survival plots. Comparisons of survival between NAC populations (delayed vs incomplete vs non-delayed) were performed using the log-rank test. Odds-ratios were generated from a logistic regression.
Results: There were 172 patients with MIBC who received NAC followed by RC. Of these patients, 49 were excluded due to incomplete NAC data. Of the remaining 123 patients, 80 (65%) received Gemcitabine and Cisplatin (Gem/Cis), 25 (20%) received dose-dense MVAC (ddMVAC), 6 (5%) received Gemcitabine and Carboplatin and 12 (10%) received other chemotherapy regimen. In the Gem/Cis cohort, 28 (35%) did not complete their planned cycles of NAC, in comparison to only 3 (12%) in the ddMVAC cohort. Of patients receiving Gem/Cis, 33 (41%) experienced a delay (mean = 21.5 Â± 17.0 days) in the administration of NAC. On the other hand, 22 (88%) patients having received ddMVAC, completed their expected course, but 7 (28%) experienced a delay (mean = 10.5 Â± 9.5 days). Receiving Gem/Cis was associated with higher likelihood of delay compared to ddMVAC (OR = 4.00; 95% CI 0.99-16.10). Administration of Gem/Cis was most commonly delayed for thrombocytopenia, neutropenia or anemia (n = 21) and discontinued altogether for acute renal failure/azotemia (n = 7). Similarly, administration of ddMVAC was most commonly delayed for acute renal failure/azotemia (n = 3) and discontinued for decline in functional status/fatigue (n = 2). Median overall survival was not significantly different between the three groups; 56.1 months (95% CI 44.1 to 68.1 months), 56.9 months (95% CI 42.9 to 70.8 months) and 67.1 months (95% CI 58.7 to 75.5 months) in the delayed, incomplete and non-delayed NAC groups, respectively.
Conclusions: Delays in administration and non-completion of NAC were commonly seen in our cohort (63%) and were most likely to occur in patients receiving Gem/Cis. Understanding the etiology of these delays can lead to early identification of patients at risk for non-completion of NAC.