Pd62-03 the Effect of Intrinsic Subtype on Response to Neoadjuvant Chemotherapy for Muscle Invasive Bladder Cancer
Year: 2017
Type: article
Abstract: You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2017PD62-03 THE EFFECT OF INTRINSIC SUBTYPE ON RESPONSE TO NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER Michael Metcalfe, Debashish Sundi, Roger Li, James Ferguson, Pretzsch Shanna, Bondaruk Jolanta, Bogdan Czerniak, Elizabeth Plimack, Neema Navai, Ashish Kamat, Colin Dinney, Jay Shah, Woonyoung Choi, and David McConkey Michael MetcalfeMichael Metcalfe More articles by this author , Debashish SundiDebashish Sundi More articles by this author , Roger LiRoger Li More articles by this author , James FergusonJames Ferguson More articles by this author , Pretzsch ShannaPretzsch Shanna More articles by this author , Bondaruk JolantaBondaruk Jolanta More articles by this author , Bogdan CzerniakBogdan Czerniak More articles by this author , Elizabeth PlimackElizabeth Plimack More articles by this author , Neema NavaiNeema Navai More articles by this author , Ashish KamatAshish Kamat More articles by this author , Colin DinneyColin Dinney More articles by this author , Jay ShahJay Shah More articles by this author , Woonyoung ChoiWoonyoung Choi More articles by this author , and David McConkeyDavid McConkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2775AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gold standard treatment for muscle invasive bladder cancer (MIBC) is radical cystectomy (RC) with neoadjuvant chemotherapy (NAC). However, the survival benefit of NAC in unselected patients is considered modest (5-15%). Recently genomic studies identified intrinsic basal, p53-like, and luminal molecular subtypes of MIBC which identify the genetic heterogeneity of bladder cancer. We hypothesized that tumor intrinsic subtype at the time of staging transurethral resection (TURBT) could be associated with clinical benefit from NAC. METHODS We identified patients with MIBC who underwent RC with or without NAC between 2000 and 2010 at three different institutions. Whole-genome analysis was performed on TURBT specimens and were classified into basal, luminal or p53-like subtypes. Primary outcome is overall survival (OS). Secondary outcome is response is tumor downstaging (<pT2 at RC). RESULTS 273 TURBT specimens were analyzed. There were no significant differences in the subtypes between age, sex and stage (p<0.05). 87 (32%) were basal, 95 (35%) were p53-like, and 91 (33%) were luminal. 127 (46%) did not get NAC, and 146 (54%) received NAC. Downstaging occurred in 69 of 273 patients (26%), 2% (2/127) did not receive NAC and 47% (69/146) received NAC (p<0.001). Of patients that received NAC, 51% (25/49) of basal, 33% (16/48) p53-like, and 57% (28/49) of luminal tumors were downstaged (p=0.033). Median OS for patients who did not receive NAC was 33 mo. vs. 102 mo. for those who did (p<0.0001). OS was improved for patients who did vs. those who did not get NAC in basal subtypes (17 mo. vs. 271 mo., p<0.001). However, there was no significant difference in OS for p53-like (58 mo. vs. 70 mo., p=0.3137), and for luminal (43 mo. vs. 85 mo., p=0.0629). For patients that did get NAC, patients with basal tumors had a significant increase in OS over to the other subtypes (p=0.0239) (Figure 1). CONCLUSIONS Basal tumors in the absence of NAC are high risk, but they have a favorable response to NAC which results in an increased OS. Luminal tumors have a favorable downstage rate at RC, but this does not translate into increased OS. P53-like tumors have a poor prognosis regardless of use of NAC. We demonstrate that the intrinsic molecular subtypes of MIBC identified at TURBT have variable response to NAC with significant implications on OS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1194 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Michael Metcalfe More articles by this author Debashish Sundi More articles by this author Roger Li More articles by this author James Ferguson More articles by this author Pretzsch Shanna More articles by this author Bondaruk Jolanta More articles by this author Bogdan Czerniak More articles by this author Elizabeth Plimack More articles by this author Neema Navai More articles by this author Ashish Kamat More articles by this author Colin Dinney More articles by this author Jay Shah More articles by this author Woonyoung Choi More articles by this author David McConkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2605156152