Analysis of Neoadjuvant Immunotherapy and Chemotherapy for Muscle-Invasive Bladder Cancer in a National Registry

Based on remarkable success in the metastatic/locally advanced space, Neoadjuvant Immunotherapy (NIO) is a promising novel treatment option for Muscle-Invasive Bladder Cancer (MIBC). Here, we assess factors associated with NIO and describe survival outcomes following NIO use in MIBC patients.

The NCDB was used to identify 5,823 qualifying patients with a diagnosis of urothelial bladder cancer, T2-4N0-3M0 clinical stage and who received NIO or NAC prior to radical cystectomy between 2006 and 2019. NAC and NIO patient groups with similar clinical and demographic characteristics were defined using a 1:1 propensity score matching method.

Mean age at diagnosis was significantly higher in NIO patients compared to NAC patients (70.22 ± 9.2 vs. 65.33 ± 9.1 years, P < .001). NAC administration correlated with an increased odds of pathologic complete response (pCR) compared to NIO in the unmatched (OR: 3.825, 95% CI: 1.972-7.417, P < .001) and matched (OR: 6.771, 95% CI: 2.624-17.473, P < .001) analyses. Finally, Cox proportional hazard model and Kaplan-Meier analysis revealed no difference in overall survival between NAC and NIO administration in the unmatched or matched analysis.

In this study, older age, higher income and longer distance to facility were associated with the use of NIO compared to NAC. NIO administration was less effective at achieving pR and pCR compared to NAC. There was no observed difference in overall survival between patients that received NIO and those that received NAC. The ongoing phase III trials in this space should help to clarify the role of NIO.