One-Two Punch Improves Bladder Cancer Odds
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.
Another problem with this regimen are its side effects: MVAC therapy is considered to be among the most difficult chemotherapy regimens to tolerate. Some small preliminary studies of a different, less toxic combination -- cisplatin and gemcitabine -- suggest that it, too, may be useful for locally advanced bladder cancer.
Also, Natale says, with only 317 patients examined, other researchers may feel the study is too small for the findings to be generalized. He says that one study should not change clinical practice.
Nonetheless, the survival difference is very impressive. And some patients could be treated with bladder-sparing surgery. He says that after chemotherapy, the bladder could be examined using a cystoscope, a tiny tube with a lens on it that can be threaded through the urethra so the doctor can examine the inner surface of the bladder.
"Several biopsies can be taken using the cystoscope, and then the urine and blood can be checked for [any evidence of cancer]," he says. If those tests are negative, the patient might avoid surgery but would need to be followed closely for at least two years, Natale says. "That would mean following every three months," he says.
Kuban says some institutions are already routinely doing bladder-sparing therapies using chemotherapy combined with radiation therapy.
"They are doing this at Massachusetts General [Hospital, in Boston,] and about 40% of the patients are able to keep their bladders," she says.