Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Muscle invasive (MIBC) and metastatic (mBC) Urothelial cancer: modern treatment practices and clinical outcomes in Victoria   (#190)

Phuong Phan 1 , Wanda Cui 2 , Kubra Goz 3 , Claudia Corrente 1 , Olivia Baenziger 1 , Shirley Wong 4 , Phil Dundee 5 , Homi Zargar 5 6 , Paul Anderson 5 6 , Nathan Lawrentschuk 2 6 7 , Peter Gibbs 1 , Andrew Weickhardt 7 , Lih-Ming Wong 3 , Shomik Sengupta 8 , Ben Tran 1 2
  1. Walter and Eliza Hall Institute, Melbourne
  2. Peter MacCallum Cancer Centre, Melbourne
  3. St Vincents, Melbourne
  4. Western Health, Melbourne
  5. Royal Melbourne Hospital, Melbourne
  6. Epworth Healthcare, Melbourne
  7. Austin Health, Melbourne
  8. Eastern Health, Melbourne

Aim

To examine the real-world treatment practices and outcomes of urothelial cancer patients

 

Method

Patients with muscle invasive (MIBC) or metastatic (mBC) urothelial cancer were identified from 7 sites from 2011 to 2018. Clinico-pathologic and survival data were collected into a registry according to a predefined multidisciplinary data dictionary. Descriptive statistics were used, with differences in populations examined using Fishers exact test. Survival analyses used the Kaplan-Meir method and were compared using the log rank test.  Astra Zeneca contributed funding to the set up and maintenance of this registry.

 

Results

We identified 136 patients with MIBC or mBC. Out of 109 (81%) with MIBC as initial diagnosis, 98 (89%) proceeded to definitive treatment of the primary, predominantly surgical (n=84, 86%). A minority (45%) received perioperative chemotherapy (neoadjuvant or adjuvant), typically cisplatin and gemcitabine. For MIBC patients treated curatively, median recurrence free survival (RFS) was 35.1 months in the neoadjuvant group (n=20), 25.5 months in the adjuvant group (n=20), and 15.8 months in the no chemo group (neoadj vs adj p=0.07; neoadj vs none p=0.01; adj vs none p=NS).

 

Our cohort included 72 mBC patients. 27 had de novo mBC and 45 had metastatic recurrence following initial MIBC diagnosis. 65% (n=47) received 1st line treatment, commonly platinum doublet chemotherapy (n=39, 82%).  Of those with disease progression, 59% proceeded to 2nd line, commonly with paclitaxel or immunotherapy (IO).  Only 30% went on to receive 3rd line treatment.

 

Conclusions

Our real world study reproduces existing data demonstrating improved RFS with neoadjuvant chemotherapy for MIBC. We also report that less than 60% of patients who receive 1st line treatment for mBC go on to receive 2nd line treatment. A better understanding of treatment practices may help guide clinical trial design in urothelial cancer.