NEW ORLEANS, LA USA (UroToday.com) - Despite level I evidence showing an improved overall survival in patients undergoing neoadjuvant chemotherapy (NAC), only about 20% of muscle-invasive bladder cancer (MIBC) patients undergo NAC in the United States. Patients who were eligible for NAC can become ineligible for cisplatin-based adjuvant chemotherapy (AC) if the renal function declines to GFR < 50 after radical cystectomy (RC). The group from Fox Chase Cancer Center sought to determine patient demographic and comorbidity history, including the use of NAC, impacting the decline of renal function to a threshold where platinum-based AC is no longer feasible.

Three hundred fifteen patients underwent RC between 2006 and 2011 and were identified from the institutional registry. Patients were included if their GFR was > 50 preop and they had a pathological diagnosis of primary urothelial MIBC. Adjusting for patient variables (age, gender, race), comorbidities (preop anticoagulation, CAD, afib/MI/PE, HTN, DM, DVT), receipt of NAC, intraoperative factors (EBL) and postoperative factors (Length of stay), logistic regressions were used to examine the determinants of eGFR < 50 measured anytime within 3 months postoperatively.

One hundred eighty-seven patients met criteria. Fifty-seven underwent NAC, and 130 patients did not. Of patients without NAC, 39 patients experienced a decline in eGFR < 50 (30%). On univariate analysis, presence of DM (OR 2.41, 95% CI 1.07-5.46) and presence of HTN (OR 2.37, 95% CI 1.24-4.53) were the only factors associated with increased risk of GFR decline < 50. In a multivariable model, only HTN (OR 2.26, 95% CI 1.05-4.84) was associated with increased risk. Receipt of NAC was not associated with GFR decline in either adjusted or unadjusted models.

The group concludes that up to 30% of patients with normal GFR preoperatively may become ineligible for platinum-based systemic therapy after RC based on renal function decline alone. Patients with medical comorbidities such as HTN and DM are particularly sensitive to this decline and should be encouraged to undergo NAC.

Presented and reported by Mohammed Haseebuddin, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA

Fox Chase Cancer Center, Philadelphia, PA USA

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