FAVOURABLE survival outcomes have been discovered with neoadjuvant immunotherapy when compared with upfront radical cystectomy in patients with muscle-invasive bladder cancer (MIBC).
This research studied data from 18,483 patients using the National Cancer Database, all of whom underwent radical cystectomy for localised MIBC between 2014–2019. By using nearest-neighbour propensity-score caliper matching, the investigators defined three groups, each branch of which was made up of 280 patients. These were based on similar baseline characteristics, and labelled as neoadjuvant immunotherapy, neoadjuvant chemotherapy, and a group not receiving neoadjuvant treatment, respectively.
Pathologic downstaging rate to pT0N0 was significantly higher for the neoadjuvant immunotherapy and chemotherapy groups when compared with upfront surgery (22.5% and 26.4% versus 6.7%, respectively). Additionally, neoadjuvant immunotherapy and chemotherapy were significantly associated with four- and five-fold increased odds of pathologic downstaging, when compared to upfront surgery. Overall survival rate also favoured neoadjuvant therapy. Meanwhile, all-cause mortality was significantly 32% and 38% lower with neoadjuvant immunotherapy and chemotherapy, respectively. The researchers were able to conclude that patients with downstaging after neoadjuvant immunotherapy displayed an overall survival benefit compared to patients without downstaging.
The next steps in this field are highlighted as Phase III trials, in order to test the noninferiority of neoadjuvant immunotherapy to neoadjuvant chemotherapy. The investigators did note that, as this study was observational, they could not rule out the possibility of confounding by indication. Results from this work encourage the use of this alternative treatment of MIBC, and are expected to shape the future course of intervention for this condition.
