Neoadjuvant Chemotherapy in Elderly Patients with Bladder Cancer: Oncologic Outcomes from a Single Institution Experience

Abstract Purpose To determine if in appropriately selected elderly patients receiving NAC, clinical outcomes including pathologic complete response/down-staging and overall survival were similar to a younger cohort. Methods Chart review was performed on patients receiving NAC for UCB from 2004 to 20...

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Published in:Clinical genitourinary cancer 2017-08, Vol.15 (4), p.e583-e589
Main Authors: Leone, Andrew R., MD, Zargar-Shoshtari, Kamran, MD, Diorio, Gregory J., DO, Sharma, Pranav, MD, Boulware, David, MS, Gilbert, Scott M., MD, Powsang, Julio M., MD, Zhang, Jingsong, MD, Sexton, Wade J., MD, Spiess, Philippe E., MD, Poch, Michael A., MD
Format: Article
Language:English
Subjects:
Adjuvant chemotherapy
Adult
Aged
Aged, 80 and over
Carcinoma, Transitional Cell - drug therapy
Chemotherapy, Adjuvant - methods
Cystectomy
Female
Hematology, Oncology and Palliative Medicine
Humans
Male
Middle Aged
Neoadjuvant Therapy
Retrospective Studies
Risk Factors
Survival
Survival Analysis
Treatment Outcome
Urinary bladder neoplasms
Urinary Bladder Neoplasms - drug therapy
Urology
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Summary:Abstract Purpose To determine if in appropriately selected elderly patients receiving NAC, clinical outcomes including pathologic complete response/down-staging and overall survival were similar to a younger cohort. Methods Chart review was performed on patients receiving NAC for UCB from 2004 to 2013. 116 patients were identified that underwent NAC from 2004-2013 for ≥ cT2N0M0 urothelial carcinoma of the bladder. Patients were excluded who received two cycles or less of chemotherapy (N= 18, 11 patients in the younger cohort, 7 in the elderly group, p=0.74). Data was using appropriate analyses and Kaplan-Meir analysis curves used for survival and recurrence. Results Forty-six elderly patients (age ≥70) (67% cisplatin-based regimen ) were identified and compared with 70 (93% cisplatin-based regimen ) younger patients. Estimated Glomerular filtration (eGFR), Performance status, preoperative hemoglobin, and BMI were significantly worse in elderly patients. Dose reduction and pathological down-staging to non-muscle invasive disease was not statistically different between older and younger patients Complete pathological response (16%) in older patients vs. (17%) in younger cohort were similar (p=0.146). There was no significant difference in follow up, recurrence or in median overall survival between patient groups (28 months elderly vs. 35 months younger, p=0.78). Age was not an independent predictor of pathological down-staging, complete response, overall survival, or recurrence free survival. Conclusions NAC in elderly patients (≥70 years old) demonstrate equivalent toxicity and oncological outcomes in our single institution cohort. Although older patients had significantly poorer performance status and renal function there were no differences in survival or response to NAC.
ISSN:1558-7673
1938-0682
DOI:10.1016/j.clgc.2017.01.014