Barriers That Prevent Access to Optimal Treatment in Primary Urethral Cancer

Despite neoadjuvant chemotherapy followed by surgery providing a 7% increase in 5-year overall survival for patients with primary invasive urethral cancer, only 19% of patients actually receive this treatment. The biggest challenge is ensuring community practices are incorporating this treatment change, but there is also an onus on the overall medical field to ensure all patients who are eligible are receiving neoadjuvant chemotherapy followed by surgery, said Rohan Garje, MD, chief of Genitourinary Medical Oncology at Baptist Health Miami Cancer Institute.

This transcript has been edited; captions were auto-generated by AI.

Transcript

In your real-world analysis, patients with invasive primary urethral cancer undergoing neoadjuvant chemotherapy followed by surgery had the best disease-free survival rate, but only 19% of patients had received this treatment. Why isn't it used more frequently?

Neoadjuvant chemotherapy definitely has shown a survival benefit. There is good enough evidence of a big meta-analysis, which definitely showed improvement of 5-year overall survival by 7%. Now, obviously, we knew about this data long [ago], but the biggest challenge is incorporating [the knowledge] into community-based practices.

There may be some genuine reasons where patients are ineligible for neoadjuvant chemotherapies in urothelial cancers, where their renal function is poor or overall ECOG performance is not good enough for them to receive neoadjuvant treatment, which hopefully will change with the current paradigm, where we are exploring non–platinum-based approaches. Hopefully, patients will be more eligible to [receive] those systemic therapies. Some patients may have conflicting acute issues, pain, or bleeding, when they cannot wait for neoadjuvant chemotherapy for various reasons, so they go for upfront surgeries.

But definitely, there is a huge onus on the medical field, especially we need to discuss these patients in tumor boards, multidisciplinary collaboration, where all patients receive neoadjuvant chemo and followed by surgery when there is an indication for that approach, and also discuss about adjuvant treatment options.

Multimodal therapy requires close coordination among specialists. How should this coordination be handled to be most effective?

It's important to have multidisciplinary conversations, and also multidisciplinary clinics where patients with muscle-invasive urothelial cancer get to see medical oncologists, surgeons, and radiation oncologists, who come up with a comprehensive treatment strategy. I think that is key for achieving a better outcome for these patients.