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One-Two Punch Improves Bladder Cancer Odds

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WebMD Health News

May 14, 2001 (San Francisco) -- Exciting results from a new cancer study might just change the way some people with bladder cancer are treated -- and double their odds of survival.

Bladder cancer is the sixth most common cancer in the U.S. More than 50,000 new cases of the disease will be diagnosed this year, according to the American Cancer Society, and just over 12,000 people will die from it. Most of those diagnosed are men.

Early bladder cancer affects just the delicate interior surface of the bladder. But as the cancer spreads it invades the muscle that surrounds the bladder. At this stage it usually can be detected by the presence of blood in the urine, says cancer researcher and study leader Ronald B. Natale, MD.

Currently, most people with this stage of bladder cancer, called locally advanced disease, undergo total removal of the bladder, a procedure called radical medical cystectomy. Unfortunately, many of these people go on to have recurrence of the cancer because they harbor an undetectable amount of cancer cells in their blood.

In this study, about 300 patients with locally advanced bladder cancer received three cycles of chemotherapy with four drugs -- methotrexate, vinblastine, doxorubicin, and cisplatin (or MVAC for short) -- before their surgery. The treatment took about three months, and then the patients were allowed to recuperate for about 2 to 3 weeks before undergoing bladder removal.

The chemotherapy appears to have cured almost 40% of the patients, Natale tells WebMD, according to tests performed on the bladders that were removed.

"These patients had no evidence of cancer at the time of surgery," says Natale, who is acting director of Cedars-Sinai Comprehensive Cancer Center in Los Angeles. The pathologists who examined the bladders after surgery confirmed that the cancer was indeed gone, he says.

The researchers tracked the patients for more than seven years. Eighty-five percent lived five years or longer -- which is nearly twice the survival rate of patients who undergo surgery alone.

"[This is] a real breakthrough in the magnitude of survival," says Deborah A. Kuban, MD. "A difference of over two years is really significant for treatment of any cancer."

Kuban, a professor of oncology at M.D. Anderson Cancer Center in Houston, was not involved in this study but commented on the findings for WebMD.

Although the results from this trial are very promising, Natale says, cancer doctors may want to see them repeated in future studies before recommending this strategy to their patients. Although they're encouraging, these results come on the heels of seven studies that failed to find a chemotherapy regimen that improves survival in people with bladder cancer.

Those trials used other chemotherapy regimens before surgery, he notes.

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