Circulating tumour cells could aid in the decision to give neoadjuvant chemotherapy

The benefit of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer and no circulating tumour cells detectable may be limited. Although the CirGuidance study did not meet its primary endpoint, counting the number of circulating tumour cells at the moment of diagnosis could still aid in the decision to give neoadjuvant chemotherapy for patients with muscle-invasive bladder cancer [1].

Although international guidelines for the treatment of non-metastatic muscle-invasive bladder cancer recommend neoadjuvant chemotherapy, this treatment modality is underutilised in the clinic. In the Netherlands, only 20% of patients receive neoadjuvant chemotherapy. “Hence, there is a need for biomarkers to guide treatment decision-making on neoadjuvant chemotherapy,” explained Dr Nick Beije (Erasmus Medical Center, Rotterdam, the Netherlands). Circulating tumour cells (CTCs) are a strong prognostic marker in muscle-invasive bladder cancer for overall survival (OS), progression-free survival (PFS), and cancer-specific survival in these patients. Hypothesised was that the absence of CTCs might identify patients with such a good prognosis that neoadjuvant chemotherapy is not justified.

The observational, multicentre CirGuidance study (NTR4120) included adults with clinical stage T2-T4a N0-N1 M0 muscle-invasive urothelial carcinoma of the bladder who were fit to undergo radical cystectomy. Patients with no detectable CTCs underwent radical surgery without neoadjuvant chemotherapy, whereas patients with ≥1 detectable CTC were advised to receive neoadjuvant chemotherapy followed by radical surgery; neoadjuvant chemotherapy could be refused.

Of 315 patients screened for eligibility, 273 patients (median age 69 years) were enrolled in the study. A total of 203 patients were CTC-negative and 70 were CTC-positive. The study did not meet the primary endpoint of OS >75%. In CTC-negative patients, OS was 69.5% versus 58.2% in CTC-positive patients. However, CTC-positive patients had better OS when they received neoadjuvant chemotherapy. In CTC-positive patients, cancer-related mortality (HR 1.61; 95% CI 1.05–2.45; P=0.03) and the incidence of relapse (HR 1.87; 95% CI 1.28–2.73; P=0.001) were higher than in CTC-negative patients. Dr Beije concluded that CTCs may still be a valuable biomarker as an addition to other already available markers.

1. Beije N. Circulating tumour cell-driven use of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: final results of the CirGuidance study. Game changing session 3, EAU21 Virtual, 8–12 July 2021.

 

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Posted on 31 August 202117 May 2024