Early Cessation of Neoadjuvant Chemotherapy May Lead to Worse Outcomes in Patients With Muscle-Invasive Bladder Cancer

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Patients with muscle-invasive bladder cancer who receive fewer than three cycles of chemotherapy prior to cystectomy may have an increased risk of cancer recurrence and worse survival outcomes, according to the findings of a retrospective study presented by Chakraborty et al at the 2023 ASCO Annual Meeting (Abstract 4586).


The standard of care for patients with muscle-invasive bladder cancer is to receive at least three cycles of chemotherapy prior to cystectomy or partial cystectomy. However, not all patients complete three cycles. Some halt chemotherapy after one or two cycles as a result of toxicity-related adverse effects such as nausea or anemia.

“There really hasn’t been any research looking into less than three cycles of chemotherapy for these patients. Our study looked into the outcomes … to see if we could find any differences compared [with] those who receive the standard treatment of three [full] cycles,” explained lead study author Anumita Chakraborty, MD, an internal medicine resident at Temple University Hospital at Temple Health.

Study Methods and Results

In the new study, researchers reviewed the anonymous health records of 195 patients who were diagnosed with muscle-invasive bladder cancer between 2004 and 2017. They then compared the recurrence and survival rates of 30 patients who received fewer than three cycles of neoadjuvant chemotherapy with the rates of 165 patients who received three or more cycles.

The researchers compared three outcomes between the two patient groups—pathologic response, cancer recurrence, and overall survival—and found that patients who completed fewer than three cycles of chemotherapy had worse outcomes on all three measures compared with those receiving three cycles or more. These patients were less likely to demonstrate pathologic or complete pathologic responses, their cancer tended to recur more quickly, and they had a 40% lower 5-year survival rate.


The researchers emphasized that although these findings may have important implications for patients and clinicians, they need to be confirmed in additional prospective studies. “If patients are able to tolerate the three cycles of neoadjuvant chemotherapy, clinicians should encourage and try to support patients to receive all three cycles,” underscored Dr. Chakraborty, adding that the study’s outcomes may also guide clinicians’ screening practices. “Patients who receive less than three cycles would need to be followed very closely after treatment to monitor for recurrence because they have a significantly higher recurrence rate,” she concluded.

Disclosure: For full disclosures of the study authors, visit

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