Eligibility and Radiologic Assessment in Adjuvant Clinical Trials in Bladder Cancer.

Journal Article (Journal Article)

Objective

To harmonize eligibility criteria and radiographic disease assessments in clinical trials of adjuvant therapy for muscle-invasive bladder cancer (MIBC).

Methods

National experts in bladder cancer clinical trial research, including medical and urologic oncologists, radiologists, biostatisticians, and patient advocates, convened at a public workshop on November 28, 2017, to discuss eligibility, radiographic entry criteria, and assessment of disease recurrence in adjuvant clinical trials in patients with MIBC.

Results

The key workshop conclusions for adjuvant MIBC clinical trials included the following points: (1) patients with urothelial carcinoma with divergent histologic differentiation should be allowed to enroll; (2) neoadjuvant chemotherapy is defined as at least 3 cycles of neoadjuvant cisplatin-based combination chemotherapy; (3) patients with muscle-invasive, upper-tract urothelial carcinoma should be included in adjuvant trials of MIBC; (4) patients with severe renal insufficiency can enroll into trials using agents that are not renally excreted; (5) patients with microscopic surgical margins can be included; (6) patients should undergo a standard bilateral lymph node dissection prior to enrollment; (7) computed tomographic (CT) imaging should be performed within 4 weeks prior to enrollment. For patients with renal insufficiency who cannot undergo CT imaging with contrast, noncontrast chest CT and magnetic resonance imaging of the abdomen and pelvis with gadolinium should be done; (8) biopsy of indeterminate lesions to evaluate for malignant disease should be done when feasible; (9) a uniform approach to evaluate indeterminate radiographic lesions when biopsy is not feasible should be included in any trial design; (10) a uniform approach to determining the date of recurrence is important in interpreting adjuvant trial results; and (11) new high-grade, upper-tract primary tumors and new MIBC tumors should be considered recurrence events.

Conclusions and relevance

A uniform approach to eligibility criteria, definitions of no evidence of disease, and definitions of disease recurrence may lead to more consistent interpretations of adjuvant trial results in MIBC.

Full Text

Duke Authors

Cited Authors

  • Apolo, AB; Milowsky, MI; Kim, L; Inman, BA; Kamat, AM; Steinberg, G; Bagheri, M; Krishnasamy, VP; Marko, J; Dinney, CP; Bangs, R; Sweis, RF; Maher, VE; Ibrahim, A; Liu, K; Werntz, R; Cross, F; Beaver, JA; Singh, H; Pazdur, R; Blumenthal, GM; Lerner, SP; Bajorin, DF; Rosenberg, JE; Agrawal, S

Published Date

  • December 2019

Published In

Volume / Issue

  • 5 / 12

Start / End Page

  • 1790 - 1798

PubMed ID

  • 31670753

Pubmed Central ID

  • PMC8211913

Electronic International Standard Serial Number (EISSN)

  • 2374-2445

International Standard Serial Number (ISSN)

  • 2374-2437

Digital Object Identifier (DOI)

  • 10.1001/jamaoncol.2019.4114

Language

  • eng