Clinical Complete Response after Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer: A Call for Standardized Assessments and Definitions

Jared Winoker, Christine W. Liaw, Matthew D. Galsky, Peter Wiklund, Reza Mehrazin

Research output: Contribution to journalReview article

Abstract

The ability to accurately determine a complete clinical response (cCR) to neoadjuvant chemotherapy (NAC) before cystectomy could have paradigm-shifting implications for the management of muscle-invasive bladder cancer. Level 1 evidence demonstrates that up to 40% of patients are downstaged to pT0 disease following NAC, presenting an intriguing opportunity to identify select patients who might be spared the morbidity of radical surgery. However, clinical investigations in this space are hindered by lack of a uniform approach to postchemotherapy restaging and a standardized definition of cCR. Patient summary: In this mini-review, we discuss the current limitations to restaging of muscle-invasive bladder cancer following neoadjuvant chemotherapy and their implications for personalized medicine and translational research. We conclude that there is an unmet need to optimize and standardize restaging evaluation and definitions of a complete clinical response. There is no standardized approach to restaging after neoadjuvant chemotherapy or consensus definition of a clinical complete response, limiting our ability to advance precision medicine and bladder preservation strategies in muscle-invasive bladder cancer.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Urinary Bladder Neoplasms
Drug Therapy
Muscles
Precision Medicine
Translational Medical Research
Cystectomy
Urinary Bladder
Morbidity

Keywords

  • Bladder cancer
  • Bladder preservation
  • Clinical response
  • Muscle-invasive bladder cancer
  • Neoadjuvant chemotherapy

ASJC Scopus subject areas

  • Urology

Cite this

Clinical Complete Response after Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer : A Call for Standardized Assessments and Definitions. / Winoker, Jared; Liaw, Christine W.; Galsky, Matthew D.; Wiklund, Peter; Mehrazin, Reza.

In: European Urology Focus, 01.01.2019.

Research output: Contribution to journalReview article

@article{2c2d360c7cc2460c9f495e7a274044d1,
title = "Clinical Complete Response after Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer: A Call for Standardized Assessments and Definitions",
abstract = "The ability to accurately determine a complete clinical response (cCR) to neoadjuvant chemotherapy (NAC) before cystectomy could have paradigm-shifting implications for the management of muscle-invasive bladder cancer. Level 1 evidence demonstrates that up to 40{\%} of patients are downstaged to pT0 disease following NAC, presenting an intriguing opportunity to identify select patients who might be spared the morbidity of radical surgery. However, clinical investigations in this space are hindered by lack of a uniform approach to postchemotherapy restaging and a standardized definition of cCR. Patient summary: In this mini-review, we discuss the current limitations to restaging of muscle-invasive bladder cancer following neoadjuvant chemotherapy and their implications for personalized medicine and translational research. We conclude that there is an unmet need to optimize and standardize restaging evaluation and definitions of a complete clinical response. There is no standardized approach to restaging after neoadjuvant chemotherapy or consensus definition of a clinical complete response, limiting our ability to advance precision medicine and bladder preservation strategies in muscle-invasive bladder cancer.",
keywords = "Bladder cancer, Bladder preservation, Clinical response, Muscle-invasive bladder cancer, Neoadjuvant chemotherapy",
author = "Jared Winoker and Liaw, {Christine W.} and Galsky, {Matthew D.} and Peter Wiklund and Reza Mehrazin",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.euf.2019.08.009",
language = "English (US)",
journal = "European Urology Focus",
issn = "2405-4569",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Clinical Complete Response after Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer

T2 - A Call for Standardized Assessments and Definitions

AU - Winoker, Jared

AU - Liaw, Christine W.

AU - Galsky, Matthew D.

AU - Wiklund, Peter

AU - Mehrazin, Reza

PY - 2019/1/1

Y1 - 2019/1/1

N2 - The ability to accurately determine a complete clinical response (cCR) to neoadjuvant chemotherapy (NAC) before cystectomy could have paradigm-shifting implications for the management of muscle-invasive bladder cancer. Level 1 evidence demonstrates that up to 40% of patients are downstaged to pT0 disease following NAC, presenting an intriguing opportunity to identify select patients who might be spared the morbidity of radical surgery. However, clinical investigations in this space are hindered by lack of a uniform approach to postchemotherapy restaging and a standardized definition of cCR. Patient summary: In this mini-review, we discuss the current limitations to restaging of muscle-invasive bladder cancer following neoadjuvant chemotherapy and their implications for personalized medicine and translational research. We conclude that there is an unmet need to optimize and standardize restaging evaluation and definitions of a complete clinical response. There is no standardized approach to restaging after neoadjuvant chemotherapy or consensus definition of a clinical complete response, limiting our ability to advance precision medicine and bladder preservation strategies in muscle-invasive bladder cancer.

AB - The ability to accurately determine a complete clinical response (cCR) to neoadjuvant chemotherapy (NAC) before cystectomy could have paradigm-shifting implications for the management of muscle-invasive bladder cancer. Level 1 evidence demonstrates that up to 40% of patients are downstaged to pT0 disease following NAC, presenting an intriguing opportunity to identify select patients who might be spared the morbidity of radical surgery. However, clinical investigations in this space are hindered by lack of a uniform approach to postchemotherapy restaging and a standardized definition of cCR. Patient summary: In this mini-review, we discuss the current limitations to restaging of muscle-invasive bladder cancer following neoadjuvant chemotherapy and their implications for personalized medicine and translational research. We conclude that there is an unmet need to optimize and standardize restaging evaluation and definitions of a complete clinical response. There is no standardized approach to restaging after neoadjuvant chemotherapy or consensus definition of a clinical complete response, limiting our ability to advance precision medicine and bladder preservation strategies in muscle-invasive bladder cancer.

KW - Bladder cancer

KW - Bladder preservation

KW - Clinical response

KW - Muscle-invasive bladder cancer

KW - Neoadjuvant chemotherapy

UR - http://www.scopus.com/inward/record.url?scp=85071721840&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071721840&partnerID=8YFLogxK

U2 - 10.1016/j.euf.2019.08.009

DO - 10.1016/j.euf.2019.08.009

M3 - Review article

C2 - 31494093

AN - SCOPUS:85071721840

JO - European Urology Focus

JF - European Urology Focus

SN - 2405-4569

ER -