Page 5 - CUA2019 Abstracts - Oncology-Bladder

2019 CUA Abstracts

ogy were associated with a higher risk of PR (p<0.0001 for all). PC was subjects were those with biopsy-proven bladder cancer (cTanyN1-3M0)
associated with higher risk of PR (p<0.0001), with the highest risk in those undergoing curative-intent open radical cystectomy and urinary diver-
who underwent chemotherapy with consolidation surgery (subhazard sion by one of two fellowship-trained urologic oncologists at the UAH.
ratio 3.01; 95% confidence interval 2.10, 4.31). The most frequent sites The CERP was implemented in August 2017. The CERP had 26 compo-
of LN recurrences (Fig. 1) were the RP below the IMA (23%) and left com- nents, including same-day admission, carbohydrate fluid loading, targeted
mon iliac artery (13%). ST recurrences were found near the bifurcation intraoperative fluid resuscitation, regional postoperative analgesia, early
of left (30%) and right (26%) common iliac arteries (Fig. 2). mobilization, and chewing gum use. The primary endpoint was length
Conclusions: Pelvic and lower RP recurrences after RC are found near of hospital stay (LOS). Secondary endpoints were 30-day mortality rate,
vessel bifurcations, and posterior to certain vessels. First PR is associated SAE, and readmission to hospital. Statistical tests were two-sided (p≤0.05).
with high-risk pathological features at RC and receipt of PC. This study Results: Data were evaluated for 48 subjects managed with CERP and
can help identify sites vulnerable to in-field recurrence and may guide 51 subjects not managed with CERP. Baseline demographic, clinical,
intraoperative or adjuvant therapy. and pathological characteristics did not differ between groups (all com-
This paper has figures, which may be viewed online at: parisons, p>0.05). Median LOS was nine days (range 7–12 days) in the
https://2019.cua.events/webapp/lecture/77 CERP group vs. 13 days (range 9–16) in the non-CERP group (p<0.05).
SAE occurred in three subjects (6%) in the CERP group vs. six subjects
MP-2.13 (12%) in the non-CERP group (p<0.05). Thirty-day mortality (0% vs. 0%)
and hospital readmission (19% vs. 16%) did not differ between groups.
Cost of managing metastatic bladder cancer with the introduction Conclusions: The UAH CERP was associated with decreased LOS and
of immunotherapies from a Canadian healthcare perspective SAE with no increase in perioperative mortality or readmission to hospital.
Côme Tholomier , Sara Nazha , Wassim Kassouf , Alice Dragomir CERPs provide an opportunity to improve bladder cancer quality of care.
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1 Department of Surgery, Division of Urology, McGill University Health
Centre, Montréal, QC, Canada
Introduction: The development of immunotherapies (IOs) for the treat- UP-2.1
ment of bladder cancer in first- and second-line, namely pembrolizumab Human-derived 3D bladder cancer models reconstructed by
and atezolizumab, increased the economic burden of this disease. We tissue engineering: On the road to precision medicine
aimed to use an economic model to compare the additional cost when Cassandra Ringuette-Goulet PhD , Stéphane Chabaud PhD , Geneviève
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IOs are included in the treatment algorithm of metastatic bladder cancer. Bernard MSc , Frédéric Pouliot , Stéphane J. Bolduc 1
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Methods: The model evaluated overall survival (OS), progression-free sur- 1 Surgery, CHU de Québec-Université Laval Research Centre, Québec
vival, and costs associated with each drug; adverse event (AE) treatment; City, QC, Canada
monitoring; and post-progression (third-line treatment, best supportive CUOG
care [BSC]). Efficacy, safety, and treatment duration were estimated from Introduction: Bladder cancer (BCa) is one of the most common cancers.
regimens’ pivotal clinical trials. The model included first-line gemcitabine- If the majority of BCa are non-invasive (85%), they have a high rate of
cisplatin (Gem-Cis), gemcitabine-carboplatin (Gem-Carb), or IOs in Cis- recurrence. The role of the tumour microenvironment (TME) has been
ineligible patients and high PD-L1 expression, and second-line IOs, Gem- demonstrated for the initiation, progression, and metastasis steps. A major
Carb, paclitaxel or docetaxel. Cost of BSC and AEs was retrieved from concern in cancer research is the translation of the results from bench
published Canadian studies. Sensitivity analyses were conducted to take to patients. The 2D culture systems and in vivo animal models poorly
into consideration potential rebates to IOs in hospital. replicate the dynamic nature of the human TME, with a translation rate
Results: The cost of treating patients with Gem-Cis first-line was estimated of about 7%. New models mimicking TME and maintaining heterogene-
to be $16 339, with 53% of cost related to the management of AEs. When ity of cells are needed and we propose human-derived 3D BCa models
treating patients in the second-line setting, the incremental survival of reconstructed by tissue engineering using not only BCa cell line spheroids,
pembrolizumab and atezolizumab compared to paclitaxel/docetaxel were but also patient BCa biopsies.
3.3 and 4.1 months, respectively. Treatment with second-line therapy Methods: Epithelial and mesenchymal cells from healthy bladder biopsies
costs $64 207, $54 857, $14 119, and $14 154 for pembrolizumab, were extracted and banked. Bladder mesenchymal cells were cultured for
atezolizumab, paclitaxel, and docetaxel, respectively. Cost of managing four weeks in the presence of ascorbate to produce a tissue-like scaffold.
AEs represented <1% for IOs and 10% for paclitaxel/docetaxel. In Cis- Epithelial cells were then seeded on top of the construct and after 10 days
ineligible patients, the use of IOs in first-line increased the cost by $47 of maturation (just after formation of the basal lamina), RT4 or T24 BCa
818 (total $72 596) vs. Gem-Carb, while improving OS by 6.6 months. cell line spheroids were implanted. The constructs were then kept in cul-
Conclusions: In a Canadian setting, inclusion of IOs for treatment of ture for three additional weeks. Alternatively, spheroids were replaced by
metastatic bladder cancer in first- or second-line will increase treatment patient’s BCa biopsies (tansurethral resection of bladder tumour [TURBT]).
cost by approximately $50 000 for an incremental survival of 3–6 months. Results: As expected, invasive BCa cells (from spheroids or biopsies)
invaded the stromal compartment but non-invasive cell lines or biopsy
MP-2.14 specimen (low-grade) remained superficial on the reconstructed tissue.
BCa biopsies could be maintained at least 90 days in culture and pre-
Prospective implementation of enhanced recovery after surgery sented heterogeneity of cell morphology.
to radical cystectomy at the University of Alberta Hospital Conclusions: Our human-derived 3D models of BCa are now ready for
Graeme Follett , Niels-E.B. Jacobsen , Nupur Agarwal , Heather Y. Ting , further TME investigations. Addition of immune cells from patients, as has
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Adrian Fairey been done with skin and vagina models at LOEX, will be the next step.
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1 Division of Urology, Department of Surgery, University of Alberta, Furthermore, the spheroid-derived model could serve as a tool to discover
Edmonton, AB, Canada; Department of Anesthesia and Pain Medicine, new drug targets and the patient-derived biopsy model to test the effects
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University of Alberta, Edmonton, AB, Canada of known drugs in the context of precision medicine.
Introduction: Enhanced recovery after surgery (ERAS) pathways have been
introduced in surgical oncology to facilitate postoperative recovery. Patients
undergoing radical cystectomy and urinary diversion for bladder cancer
may be ideal candidates for an ERAS pathway, as the potential for surgical
stress and postoperative serious adverse events (SAE) is high. We determined
whether implementation of a cystectomy enhanced recovery pathway (CERP)
improved clinical outcomes at the University of Alberta Hospital (UAH).
Methods: The study was a non-randomized, quasi-experimental design.
Data was collected between December 2015 and May 2018. Eligible
S92 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)