Bladder cancer patients who undergo chemotherapy before surgery have double the overall survival compared with patients who had their bladders removed with standard therapy, researchers reported here on Monday at the American Society of Clinical Oncology annual meeting.
There will be 54,000 new cases of bladder cancer in the US this year and the standard treatment for the illness is surgery to remove the bladder.
“Surgical removal of the bladder is the preferred, standard, first line of defense against the disease in the hopes of curing patients,” said lead author Dr. Ronald B. Natale of Cedars-Sinai Comprehensive Cancer Center in Los Angeles, California, during his presentation.
“Unfortunately, 50% to 60% of these patients have undetectable micrometastatic disease outside of the bladder at the time of their intended curative surgery,” he added.
Over the course of months, these microscopic cancerous growths can spread, grow larger and become potentially life threatening. These growths play a major role in the 12,500 deaths that occur due to bladder cancer each year, Natale explained.
Natale noted that his team believes that adding chemotherapy to surgery might reduce or eliminate the tiny amounts of cancer that later spread and grow.
In the study, Natale and colleagues tested a combination of four chemotherapy agents — methotrexate, vinblastine, doxorubicin and cisplatin–called MVAC.
In the study of 306 patients with advanced bladder cancer, half received MVAC prior to surgery and half underwent the standard treatment of bladder removal without MVAC.
“There was a difference in survival of 2.6 years for those in the MVAC-surgery group over the group that only had surgery,” Natale told meeting attendees. Those treated with chemotherapy had a median survival of 6.2 years and those with surgery alone had a median survival 3.6 years.
“This is a significant impact on survival,” he added.
In addition, the investigators “found that 38% of patients who underwent surgery to remove their bladders following the three cycles of MVAC had no evidence of cancer in their bladders,” Natale said.
“This is the first randomized study to be conducted in people with bladder cancer that yielded statistically significant and clinically meaningful improvements in survival with the MVAC chemotherapy given prior to surgical removal of the bladder,” he added.
However, Natale pointed out that confirmation by other studies is needed. He noted that the number of people enrolled in the study was small. What’s more, seven prior studies that examined the efficacy of chemotherapy before bladder removal surgery each had a negative result, he stated.
“Although one successful clinical trial cannot change standard medical practice, we feel, at the least, that the use of MVAC therapy can be used as a treatment option for people with bladder cancer who are undergoing surgical removal of their bladder,” Natale said.
While no deaths resulted from the chemotherapy, the treatment is not without significant side effects, according to Natale.
About 30% of the patients suffered a severe decrease in their white blood cell counts and others had gastrointestinal side effects — although most made a complete recovery from these side effects, he reported.
The results indicate that MVAC therapy might even be considered as a means to spare bladder cancer patients from having their bladders removed and future research should focus on this issue, Natale concluded.
Tags: cancer, microscopic, surgery