Analyzing NMIBC Recurrence in Patients on Clinical Complete Response Surveillance Protocol

A new study presented by Benjamin I. Joffe at the 24th Annual Meeting of the Society of Urologic Oncology evaluated the recurrence of non-muscle invasive bladder cancer (NMIBC) in patients under clinical complete response (cCR) surveillance protocol.

Patients who received negative cross-sectional imaging, negative cytology, and negative post-neoadjuvant chemotherapy (NAC) maximal endoscopic resection after undergoing platinum-based NAC for muscle-invasive bladder cancer (MIBC) were eligible for cCR surveillance protocol.

In the retrospective study, patients underwent cross-sectional imaging every 6 months and office cystoscopy and cytology every 3 months. Patients with concerning lesions or positive cytology received repeated transurethral resections. Researchers determined that patients with MIBC recurrence or metastases within a 6-month period did not meet cCR surveillance protocol and removed them from the study.

The study focused on outcomes, including the amount of NMIBC recurrences, the grade and stage of disease, and treatment.

Of the 61 patients with cCR, 14 (23%) reported a prior history of NMIBC. Patients spent a median time of 28.3 months (interquartile range [IQR], 10.1-58.9) in the cCR surveillance protocol. Forty-nine (80%) patients demonstrated a durable response without MIBC recurrence or metastases.

Out of all the patients, 28 (46%) underwent a median of 1 NMIBC recurrence (IQR, 1-2; range 0-7). Twenty (33%) had 1 recurrence, 5 (8%) had 2 recurrences, and 3 (5%) had 3 or more recurrences. Patients experienced a median of 11.5 months (IQR, 5.2-20.3) before recurrence.

Researchers concluded that patients with NMIBC recurrences were not more likely to develop muscle-invasive or metastatic disease. They also determined that patients with MIBC who develop a cCR following treatment with NAC can achieve a durable response without experiencing a recurrence of MIBC or metastases.

“These data are important to appropriately counsel patients that those who achieve a cCR still have a substantial risk of NMIBC recurrence and require careful surveillance,” the investigators wrote.