Adverse events during neoadjuvant chemotherapy for muscle invasive bladder cancer - a Swedish retrospective multicentre study of a clinical database

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Adverse events during neoadjuvant chemotherapy for muscle invasive bladder cancer - a Swedish retrospective multicentre study of a clinical database

Eriksson, Victoria (författare): Umeå universitet,Urologi och andrologi,Umea Univ, Sweden

Holmlund, Jennie (författare): Umeå universitet,Urologi och andrologi,Umea Univ, Sweden

Wiberg, Erik (författare): Umeå universitet,Urologi och andrologi,Umea Univ, Sweden

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Johansson, Markus (författare): Umeå universitet,Urologi och andrologi,Umea Univ, Sweden

Huge, Ylva (författare): Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Urologiska kliniken i Östergötland,Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden

Alamdari, Farhood (författare): Vastmanland Hosp, Sweden,Department of Urology, Västmanland Hospital, Västerås, Sweden

Svensson, Johan, 1978- (författare): Umeå universitet,Statistik,Umea Univ, Sweden

Aljabery, Firas (författare): Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Region Östergötland, Urologiska kliniken i Östergötland,Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden

Sherif, Amir (författare): Umeå universitet,Urologi och andrologi,Umea Univ, Sweden; Umea Univ, Sweden

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2022-08
2022
Engelska.
Ingår i: Translational Andrology and Urology. - : AME Publishing Company. - 2223-4683 .- 2223-4691. ; 11:8, s. 1105-1115

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Background: Adverse events (AEs) during neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (MIBC) are known but insufficiently reported. Clinical implications include affected cardiac, pulmonary, urinary, vascular and haematological organ systems. The main purpose was to evaluate the incidence and severity of AEs for ascertaining possible clinical significance. Further investigating possible effects of AEs on downstaging outcomes-downstaging is considered a surrogate marker for overall survival (OS).Methods: A retrospective evaluation of AEs during ongoing NAC for MIBC patients analysing individual patient data in a clinical database. We identified 687 cystectomies between 2009-2020 at four Swedish urological centres. Inclusion criteria were cT2-4aN0M0 in 261 NAC patients undergoing radical cystectomy (RC). Medical files were reviewed and AEs were assessed and graded, including detailed measurements by the Common Terminology Criteria for Adverse Events (CTCAE) v.5. Data were retrospectively analysed in SPSS statistics 27.0 with Spearman rank-order correlation coefficient and Mann-Whitney U-test (MWU).Results: A total of 251/261 patients [95% confidence interval (CI), 93-98%] experienced AEs during NAC pre-RC (mean two AEs/patient). In total, 208 (80%) patients received methotrexate, vinblastine, adriamycin (doxorubicin) and cisplatin (MVAC). In the total cohort, 200 (76.6%) received all pre-planned NAC-cycles. Most common AEs were anaemia (88.9%), thrombocytopenia (44.8%) and acute kidney injury (40.6%). Patients with prematurely terminated cycles had higher AE-grades (P=0.042 MWU). A correlation between higher AE-grades and decrease in downstaging existed, in the entire cohort (-0.133; P=0.033) and in patients undergoing all pre-planned NAC-cycles (-0.148; P=0.038). Anaemia and acute kidney injury were individually associated with decreased downstaging (-0.360, P=0.025 and -0.183, P=0.010, respectively).Conclusion: NAC in MIBC poses a significant risk for AEs before RC with clinical implications. For instance, patients terminating chemotherapy prematurely, have higher AE-grades and decreased downstaging. Further, acute kidney injury and anaemia are individually associated with decreased downstaging. We propose that early detection and prevention of AEs may increase downstaging of the primary tumour.

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Av författaren/redakt...: Eriksson, Victor ...; Holmlund, Jennie; Wiberg, Erik; Johansson, Marku ...; Huge, Ylva; Alamdari, Farhoo ...; visa fler...; Svensson, Johan, ...; Aljabery, Firas; Sherif, Amir; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Urologi och njur ...

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Av lärosätet: Linköpings universitet; Umeå universitet

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Adverse events during neoadjuvant chemotherapy for muscle invasive bladder cancer - a Swedish retrospective multicentre study of a clinical database

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