Abstract 1762P
Background
Common evolution of non-muscle invasive bladder cancer (NMIBC) is local recurrence or progression to muscle invasive bladder cancer (MIBC). Metastatic disease usually occurs only after progression to muscle invasive disease. However, some patients (pts) with NMIBC might develop metastases without progression to MIBC (mNMIBC). Yet, characteristics and clinical evolution of this atypical presentation of bladder cancer are unknown.
Methods
In this retrospective, multicentric French study, we aimed to describe clinical characteristics of mNMIBC (synchronous or metachronous). Pts with a history of MIBC (proven or suspected, histologically or radiologically), upper tract urothelial carcinoma or intra-diverticular bladder tumour were excluded. Survival was assessed using Kaplan Meier and Cox regression model.
Results
From 2005 to 2021, 70 pts were included from 17 French hospitals. Patients were mostly men (83%); median age at diagnosis for NMIBC was 63,8 years. The majority (93% of pts) had a high or very high risk NMIBC. Overall, 63% received intravesical BCG instillations and 21% of them were BCG-unresponsive; 24% of the cohort had a cystectomy. 19% of the pts had an upfront mNMIBC whereas 81% had metachronous mNMIBC. The median time to metastatic progression was 22.2 months [19,8; 54 months]. 21% of pts had lymph nodes only metastatic disease. The median overall survival from metastatic diagnosis was 27 months [16,6; NR]. The first line treatment was platinum-based chemotherapy for 84% of pts (cisplatin for 44%, and carboplatin for 40%). The objective response rate was 67%(standard deviation 0.32) (CR: 43% – PR: 24%) and the median time to treatment failure was 12.5 months [8,3; 14,7].
Conclusions
This study highlights that NMIBC can evolve to metastatic disease (upfront or metachronous presentation) without proven progression to MIBC. Objective response to platinum-based chemotherapy in the present mNMIBC cohort compared favourably with historical data in pts with metastatic urothelial carcinoma. A molecular profiling is ongoing to better understand the oncogenesis of this aggressive subtype of NMIBC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
AP-HP.
Funding
FONCER.
Disclosure
G. Pignot: Financial Interests, Personal, Expert Testimony: Janssen, Pfizer, Roche; Financial Interests, Personal, Invited Speaker: Janssen, Astellas, BMS, Ipsen, Bayer; Financial Interests, Institutional, Invited Speaker: MSD. M. Cancel: Financial Interests, Personal, Invited Speaker: Janssen, Sanofi; Financial Interests, Institutional, Research Grant: Ipsen; Financial Interests, Institutional, Invited Speaker: Janssen. D. Maillet: Financial Interests, Other: MSD, Pfizer, Astellas. S. Oudard: Financial Interests, Personal, Advisory Board, consultancy, advisory role: Sanofi; Financial Interests, Personal, Invited Speaker, public speaking and advisory role: Janssen; Financial Interests, Personal, Advisory Board, advisory role and public speaking: AstraZeneca, MSD, Merck, Astellas, Ipsen, Pfizer, Roche, Genetech; Financial Interests, Personal, Advisory Board, Advirory board and public speaking: BMS, Bayer, Novartis. D. Pouessel: Financial Interests, Institutional, Research Grant: MSD; Financial Interests, Personal, Advisory Role: AstraZeneca, Pfizer, Merck, MSD, Astellas; Financial Interests, Speaker’s Bureau: AstraZeneca, Pfizer, MSD, BMS, Astellas, Janssen, Ipsen; Financial Interests, Personal, Other: Pfizer, MSD. C. Serrate: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Other, formation: Janssen. L. Campedel: Financial Interests, Personal, Advisory Role: Pfizer, BMS, MSD. C. Dumont: Financial Interests, Personal, Advisory Role: Pfizer, Bristol Myers Squibb, Astellas Pharma; Financial Interests, Personal, Other: Ipsen, Pfizer, MSD, Janssen. D. Borchiellini: Financial Interests, Personal, Advisory Board: Astellas, AstraZeneca, Bayer, Bristol Myer Squibb, Ipsen, Janssen, Merck, Pfizer; Financial Interests, Institutional, Advisory Board: MSD; Financial Interests, Institutional, Invited Speaker, Clinical Research: Astellas, AstraZeneca, Bayer, Bristol Myer Squibb, Exelixis, Infinity, Janssen, MSD, Roche, Taiho Oncology. P. Barthelemy: Financial Interests, Personal, Advisory Board: BMS, MSD, Merck, Pfizer, Ipsen, Bayer, Janssen Cilag, Astellas, Novartis, Amgen; Financial Interests, Personal, Invited Speaker: AstraZeneca, Seagen. E. Colomba: Financial Interests, Other: Ipsen, BMS, Pfizer; Financial Interests, Advisory Role: Eisai, MSD, Ipsen, Pfizer, GSK, Tesaro, Sanofi, Janssen, Clovis, BMS. O. Huillard: Financial Interests, Personal, Invited Speaker: Sanofi, Ipsen, Novartis; Financial Interests, Personal, Advisory Board: Janssen, Bristol Myers Squibb, AstraZeneca, Pfizer, Eisai, Bayer. H.J. Boyle: Financial Interests, Personal, Advisory Role: Sanofi, Novartis, Janssen, Ipsen; Financial Interests, Personal, Other: Pfizer, BMS, Pfizer, Janssen, Astellas, Sanofi, Ipsen. F. Constans Schlurmann: Financial Interests, Personal, Advisory Board: BMS, Ipsen, MSD, Pfizer. F. Audenet: Financial Interests, Personal, Invited Speaker: VitaDX; Financial Interests, Personal, Advisory Board: UroDiag. C. Thibault: Financial Interests, Personal, Advisory Board: Janssen, Astellas, Sanofi, Ipsen, Pfizer, Merck, MSD, BMS, AstraZeneca; Financial Interests, Institutional, Funding: AstraZeneca, Sanofi. All other authors have declared no conflicts of interest.