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Bladder Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Recurrent Bladder Cancer Treatment

The prognosis for any patient with progressive or recurrent invasive bladder cancer is generally poor. Management of recurrence depends on previous therapy, sites of recurrence, and individual patient considerations. Treatment of new superficial or locally invasive tumors that develop in the setting of previous conservative therapy for superficial bladder neoplasia has been discussed earlier in this summary.

Recurrent or progressive disease in distant sites or after definitive local therapy has an extremely poor prognosis, and clinical trials should be considered whenever possible. Patients who have not received previous chemotherapy for urothelial carcinoma should be considered for chemotherapy as described above for stage IV disease. Palliative radiation therapy should be considered for patients with symptomatic tumors.

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Understanding Bladder Cancer -- Symptoms

In its early stages, bladder cancer may not have obvious symptoms. In the later stages, symptoms of bladder cancer may include: Bloody urine, most often painless, is the most common symptom. The urine color ranges from faintly rusty to deep red, sometimes containing blood clots. Blood traces, invisible to the naked eye, may show up in tests of urine samples. Frequent urinary tract infections, painful urination, a need to urinate often, and difficulty holding in urine. Weight loss...

Read the Understanding Bladder Cancer -- Symptoms article > >

Standard Treatment Options for Recurrent Bladder Cancer

Standard treatment options for patients with recurrent bladder cancer include the following:

  1. Combination chemotherapy.

Combination chemotherapy

In patients with recurrent transitional cell carcinoma, combination chemotherapy has produced high response rates, with occasional complete responses seen.[1,2]

Evidence (combination chemotherapy):

  1. Results from a randomized trial that compared methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) with single-agent cisplatin in patients with advanced bladder cancer show a significant advantage with MVAC in both response rate and median survival.[3] The overall response rate with MVAC in this cooperative group trial was 39%.
  2. Results from a randomized trial that compared MVAC with cisplatin, cyclophosphamide, and doxorubicin in 110 patients reported longer overall survival (OS) with MVAC (median survival 48.3 weeks vs. 36.1 weeks; P = .0003).[4]
  3. Results from a randomized trial that compared cisplatin, methotrexate, and vinblastine (CMV) with methotrexate plus vinblastine reported longer OS with CMV (median survival 7 months vs. 4.5 months; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.41–0.73; P = .0001).[5]
  4. In a multicenter randomized phase III trial that compared the combination of gemcitabine plus cisplatin (GC) with the MVAC regimen in 405 patients with advanced or metastatic bladder cancer, GC yielded response rates, time-to-progression, and OS (HR, 1.04; 95% CI, 0.82–1.32; P = .75) similar to MVAC, but GC had a better safety profile and was better tolerated than MVAC. Although this study was not designed to show the equivalence of the two regimens, the similar efficacy and reduced toxic effects of GC make it a reasonable alternative in patients who may not tolerate the MVAC regimen.[6][Level of evidence: 1iiA]
  5. Other chemotherapy regimens that have shown activity in metastatic bladder cancer include single-agent paclitaxel, single-agent gemcitabine, single-agent pemetrexed, carboplatin combined with either gemcitabine or paclitaxel, and gemcitabine combined with paclitaxel. There are no phase III trials demonstrating a survival or quality-of-life benefit from second-line chemotherapy.[7,8,9,10,11,12,13,14]
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