Two urology specialists at New York’s Memorial Sloan-Kettering Cancer Center say patients with invasive bladder cancer would likely have better outcomes if more doctors were treating them with a multidisciplinary approach, including chemotherapy prior to surgery.
Urologic Oncology fellow Andrew Feifer, MD, and Urology Surgeon Bernard Bochner, MD, recently presented the findings of their research to other specialists at the annual Genitourinary Cancers Symposium. In a presentation entitled “Multidisciplinary Care and Muscle-invasive Urothelial Cancer of the Bladder”, Drs. Feifer and Bochner assert that research proves there is a major benefit to treating bladder cancer with a combination of therapies.
Citing a 2003 Phase III trial, the doctors observed, “The hazard ratio for death due to bladder cancer was reduced by 33% in those patients who received combination therapy compared with those who underwent surgery alone.” They point out that a similar study conducted by the European Organization for the Research and Treatment of Cancer (EORTC) also supports the multidisciplinary approach to bladder cancer; that data showed a 7% survival advantage in bladder cancer patients who had chemotherapy prior to surgery.
But the presenters say too many clinicians are not heeding the message in this research. According to Feifer and Bochner, there is a preference in the medical community to perform surgery on patients with invasive bladder cancer first and treat them with chemotherapy afterward, if at all. This may be due to concerns about the patient’s ability to tolerate chemotherapy and anxiousness to operate before cancer spreads. But Drs. Feifer and Bochner contend that more bladder cancer patients would benefit if the order of surgery and chemotherapy were reversed, especially since bladder cancer is usually responsive to chemotherapy.
“Bladder cancer represents a major area of potential quality-of-care improvement, as advances in multidisciplinary care have not been mirrored with great acceptance among patients and providers,” Drs. Feifer and Bochner write. They say their research underscores the need for patients and doctors to better understand bladder cancer research and be willing to integrate its lessons into practice.
Muscle-invasive bladder cancer is the fourth most common type of solid tumor in men with about 70,000 new cases each year. It is more prevalent among diabetics, especially those who have been treated with the drug, Actos.
Andrew H Feifer, MD, MPH and Bernard H. Bochner, MD, “Multidisciplinary Care and Muscle-invasive Urothelial Cancer of the Bladder”, February 2014, 2014 Genitorurinary Cancer Symposium, http://gucasym.org/multidisciplinary-care-and-muscle-invasive-urothelial-cancer-bladder
Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349(9):859-866. http://www.nejm.org/doi/full/10.1056/NEJMoa022148