Meeting
2023 ASCO Genitourinary Cancers Symposium
FDG PET-CT imaging in assessing interim response to neoadjuvant cisplatin-based chemotherapy (NAC) in muscle invasive bladder cancer (MIBC): A prospective study.
Authors
Srikala S. Sridhar
Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
Srikala S. Sridhar , Nicholas Power , Rodney H. Breau , Susanna Y. Cheng , Gregory Russell Pond , Peter W. M. Chung , Ur Metser , Mark Norman Levine , Som D. Mukherjee
Organizations
Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada, London Health Sciences Centre, London, ON, Canada, Ottawa Hospital, Ottawa, ON, Canada, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, Princess Margaret Hospital, Toronto, ON, Canada, Ontario Clinical Oncology Group, Hamilton, ON, Canada, Juravinski Cancer Center, Department of Oncology, McMaster University, Hamilton, ON, Canada
Research Funding
Other
Ontario Clinical Oncology Group (OCOG)
Background: Muscle invasive bladder cancer (MIBC) is an aggressive local disease where initial staging with conventional CT imaging is often suboptimal. To explore the role of PET-CT in both staging MIBC and assessing response to neoadjuvant chemotherapy (NAC), we conducted a prospective multicentre, randomized trial known as PETMUSE. We report here the first results from the neoadjuvant substudy which assessed interim PET-CT response after 2-3 cycles of NAC and how this correlated with disease free survival (DFS) and overall survival (OS). Methods: Patients with MIBC (T2a-4a, N0-3, M0) based on transurethral resection of their bladder tumor and CT staging were randomized 2:1 to PET-CT or no PET-CT. All PET-CT patients, receiving cisplatin-based NAC underwent a second PET-CT after 2 cycles of gemcitabine and cisplatin (GC) or 3 cycles of dose dense methotrexate, vinblastine, adriamycin, cisplatin (ddMVAC) to assess for interim response. Patients were scored (1-5) by 2 independent reviewers according to the extent of metabolic response on PET-CT. Disease-free survival (DFS) and overall survival (OS) were collected. Results: Between 2016 and 2021, 291 patients were enrolled on PETMUSE of which 46 participated in the neoadjuvant substudy. Median age was 68 (51-86); 36 (78%) were male; 26 were ECOG 0 (57%); 31 (68%) were T2, 13 (28%) were T3/T4; and 35 (76%) were node negative. In terms of NAC regimens: 22 (48%) received GC, 17 (37%) split dose GC, 6 (13%) ddMVAC, and 1 (2%) MVAC. On PET-CT, 23 (50%) had a complete metabolic response, 14 (30%) had a partial metabolic response, 5 (11%) had no change or mixed response and 4 (9%) had progressive disease or new lesion on PET scan. Metabolic response on PET-CT was a statistically significant prognostic factor for both DFS and OS (see Table). Conclusions: In MIBC patients receiving cisplatin-based NAC, metabolic response seen on interim PET-CT was correlated with DFS and OS. PET-CT warrants further study in this setting as a potential early indicator of response to NAC. Clinical trial information: NCT02462239.
| Metabolic Response Score | N | Median (95% CI) RFS | 6-month (95% CI) RFS | Univariate Hazard Ratio (95% CI) | Cox Regression p-value |
|---|---|---|---|---|---|
| 1 – complete 2 – partial 3 – other | 23 14 9 | 11.9 (8.5, 16.6) 10.2 (7.5, NR) 8.1 (3.0, NR) | 88.0 (59.4, 96.9) 100 75.0 (12.8, 96.1) | Reference 1.70 (0.62, 4.63) 5.03 (1.35, 18.77) | 0.054 |
| Metabolic Response Score | N | Median (95% CI) OS | 6-month (95% CI) OS | Univariate Hazard Ratio (95% CI) | Cox Regression p-value |
|---|---|---|---|---|---|
| 1 – complete 2 – partial 3 – other | 23 14 9 | 15.7 (9.1, NR) 13.7 (8.8, NR) 8.6 (3.0, 8.7) | 93.3 (61.3, 99.0) 100 75.0 (12.8, 96.1) | Reference 1.04 (0.31, 3.42) 9.49 (2.17, 41.51) | 0.009 |
NR=not reached.
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Abstract Details
Session Type
Poster Session
Session Title
Poster Session B: Prostate Cancer and Urothelial Carcinoma
Track
Urothelial Carcinoma,Prostate Cancer - Advanced
Sub Track
Diagnostics and Imaging
Clinical Trial Registration Number
NCT02462239
Citation
J Clin Oncol 41, 2023 (suppl 6; abstr 460)
DOI
10.1200/JCO.2023.41.6_suppl.460
Abstract #
460
Poster Bd #
G20
Abstract Disclosures
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