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

• Published in: Clinical genitourinary cancer Vol. 15; no. 4; pp. 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: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2017
• 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; Neoadjuvant Therapy; Cystectomy; Urinary Bladder Neoplasms; Survival; Adjuvant Chemotherapy; Elderly patients; Neoadjuvant therapy; Adjuvant chemotherapy; Urinary bladder neoplasms
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2017.01.014

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.