Chemotherapy With Surgery Betters Survival in Sarcomatoid Urothelial Carcinoma

Rohan Garje, MD, chief of genitourinary oncology at the Miami Cancer Institute, discusses the goals of his research in assessing the outcomes of sarcomatoid vs classic urothelial carcinoma of bladder.

According to Garje, all cases of sarcomatoid urothelial carcinoma and classic urothelial carcinoma were identified from the National Cancer Database. Findings showed that patients with sarcomatoid urothelial carcinoma have a poorer prognosis than classic urothelial carcinoma, and in patients with sarcomatoid urothelial carcinoma, perioperative chemotherapy with surgery led to improved survival outcomes vs surgery alone.

Transcription:

0:10 | My big goal was to make sure to have guidance and in terms of treatment in what works best. What we did in the study was we utilized something called the National Cancer Database. We identified about 400 plus patients with this particular histology, and looked at how they present in terms of the diagnosis, and selected patients who had muscle invasive bladder cancer with regional lymph node involvement, and then compared them with patients who have classic urothelial carcinoma. Having said that, what we saw was that there was a striking decrease in survival for patients who had sarcomatoid histology compared to the ones who had the classic urothelial carcinoma histology. That is obviously a big, important finding, because it's a rare cancer and also has inferior survival.

1:02 | Now, the second important finding in the study was in the patients who received very operative chemotherapy, predominantly neoadjuvant chemotherapy, and the fraction of patients who got adjuvant chemotherapy in addition to surgery actually had better survival than the patients who had surgery alone. As a comparison, in classic variant urothelial carcinoma, the standard right now is to offer cisplatin-based chemotherapy followed by surgery, but there is no such standard for pure sarcomatoid. In the study, we did notice that even in this variant, if they get neoadjuvant and sometimes adjuvant chemotherapy, they actually had better responses, and their overall survival was better. This information is critical, for practicing clinicians where there is not much research or clinical trial driven guidance that these rare histologies do benefit with chemotherapy and can have better survival.