Contemporary use of perioperative cisplatin‐based chemotherapy in patients with muscle‐invasive bladder cancer

Raj, Ganesh V.; Karavadia, Saumil S; Schlomer, Bruce J.; Arriaga, Yull; Lotan, Yair; Sagalowsky, Arthur I.; Frenkel, Eugene P.

doi:10.1002/cncr.25429

Cited by 132 publications

(72 citation statements)

References 50 publications

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“…18 Similar to previous reports, 15,19 in the 46% of patients in this series who were ineligible for NAC, the primary reason was inadequate renal function.…”

Section: Discussionsupporting

confidence: 82%

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Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

El-Gehani

North²,

Ghosh³

et al. 2014

CUAJ

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Introduction: Neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy (RC) for muscle invasive urothelial carcinoma of the bladder improves survival. This study was undertaken to determine the rate of neoadjuvant gemcitabine and cisplatin use prior to RC and to assess its effect on the pathologic response rates and cancer-specific survival (CSS) and overall survival (OS). Methods: This retrospective chart review examined all patients having a RC between January 1, 2007 and June 30, 2011. We collected patient demographics, pre-treatment clinical stage, type of chemotherapy, post-RC pathologic data and survival data. Results: A total of 251 RC were performed of which 160 were for stage cT2-T4 urothelial carcinoma of the bladder. Of the 160 patients, 91 (57%) received neoadjuvant gemcitabine and cisplatin (GC) and 69 (43%) went straight to RC. Patients receiving neoadjuvant GC had a greater chance of achieving a pathologically lower stage compared to the untreated population: pT0 at 21% vs. 3%; non-invasive cancer at 37% vs. 10%; and organ-confined cancer at 60% vs. 33% (p < 0.001). Survival correlated with pathological stage: ≤pT3a patients had a median OS and CSS of 48.8 and 51.2 months compared to an OS and a CSS in ≥pT3b patients of 21.8 and 28.1 months, respectively (p < 0.0001). Conclusions: Neoadjuvant chemotherapy for urothelial carcinoma of the bladder is more frequently administered at our institution compared to the published literature. We have found that neoadjuvant chemotherapy increases the rate of down-staging, which is associated with a reduced the risk of death from urothelial carcinoma of the bladder.

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“…18 Similar to previous reports, 15,19 in the 46% of patients in this series who were ineligible for NAC, the primary reason was inadequate renal function.…”

Section: Discussionsupporting

confidence: 82%

“…4 While earlier studies have shown that only 1% to 5% of bladder cancer patients received NAC, there does appear to be a small increase in the use of NAC since 2003, with rates increasing to 12% to 19%. 9,15,16 In this series, 91/113 (80%) of potentially eligible patients received NAC (Fig. 1).…”

Section: Discussionmentioning

confidence: 81%

Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

El-Gehani

North²,

Ghosh³

et al. 2014

CUAJ

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“…Unfortunately, the use of neoadjuvant chemotherapy in patients undergoing cystectomy is limited, with as few as 17% of patients with T2 or greater disease receiving treatment, even at academic centers. 30,31 These low rates of use can be partially explained by patient comorbidity, especially renal insufficiency, and poor performance status. Some experts advocate for early cystectomy in patients who are unable to tolerate platinum-based chemotherapy regimens, although this remains an area of controversy.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

Quality Indicators in the Management of Bladder Cancer

Montgomery¹,

Miller²,

Weizer³

2013

J Natl Compr Canc Netw

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Bladder cancer is predominantly seen in elderly patients. With the aging United States population, the incidence and prevalence of bladder cancer are on the rise, heightening the relevance of this disease as a public health issue. Despite having one of the greatest average cancer treatment costs per patient, improvements in disease-specific survival have been subtle. Clinical guidelines based predominantly on expert opinion and randomized controlled studies offer some guidance, but adherence to these guidelines is lacking. Building awareness of quality indicators to optimize patient care represents an opportunity to improve bladder cancer outcomes. Although quality indicators exist for other disease states, widely accepted quality indicators for the management of bladder cancer have not yet been established. This article proposes an initial set of quality indicators for both non-muscle-invasive and muscle-invasive bladder cancer based on established clinical guidelines and the available literature. (JNCCN 2013;11:492-500) NCCN: Continuing Education Accreditation StatementThis activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer. There is no fee for this article. No commercial support was received for this article. The National Comprehensive Cancer Network (NCCN) is accredited by the ACCME to provide continuing medical education for physicians.NCCN designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.NCCN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center`s Commission on Accreditation.This activity is approved for 1.0 contact hour. Approval as a provider refers to recognition of educational activities only; accredited status does not imply endorsement by NCCN or ANCC of any commercial products discussed/displayed in conjunction with the educational activity. Kristina M. Gregory, RN, MSN, OCN, is our nurse planner for this educational activity.All clinicians completing this activity will be issued a certificate of participation. To participate in this journal CE activity: 1) review the learning objectives and author disclosures; 2) study the education content; 3) take the posttest with a 70% minimum passing score and complete the evaluation at http://education.nccn.org/ node/17316; and 4) view/print certificate.Release date: April 11, 2013; Expiration date: April 11, 2014. Learning ObjectivesUpon completion of this activity, participants will be able to:• Identify proposed quality indicators for non-muscleinvasive and muscle-invasive bladder cancer.• Discuss treatment recommendations and guidelines for non-muscle-invasive and muscle-invasive bladder cancer. Ms. Harrold has disclosed that she has no relevant financial relationships. Kristina M. Gregory, RN, MSN, OCN, Vice President, Clinical Information OperationsMs. Grego...

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“…In a study reported by Raj and colleagues, among 145 patients who underwent RC for preoperative clinical stage ≥T2 disease, where only 17% received cisplatin-based NC, the main reasons cited for lack of use were age, comorbidities, concerns over toxicity and the modest nature of benefit. 26 This latter point may particularly be an issue in patients with clinically staged, cT2 disease where the relative benefit from NC appears smaller compared to that of T3 or T4a disease, but nevertheless there is still a 5% OS benefit at 5 years. Another reason to offer NC to patients with cT2 disease is that a significant number of patients are upstaged at the time of RC.…”

Section: Patient Selection For Ncmentioning

confidence: 99%

Neoadjuvant chemotherapy (NC) should be administered to fit patients with newly diagnosed, potentially resectable muscle-invasive urothelial cancer (MIUC) of the bladder – A 2013 CAGMO Consensus Statement and Call for a Streamlined Referral Process

Seah

Blais

North

et al. 2013

CUAJ

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Neoadjuvant chemotherapy (NC) improves overall survival in patients with resectable muscle-invasive urothelial cancer of the bladder (MIBC). However uptake of NC in Canada is disappointingly low. Following a detailed literature review and in consultation with urologic oncology, the Canadian Association of Genitourinary Medical Oncologists (CAGMO) has developed a consensus statement for the use of NC in MIBC. Our primary goal is to increase the uptake of NC for MIBC in Canada and improve patient outcomes. IntroductionMIBC is the sixth most common malignancy diagnosed in Canada with 7800 new cases and 2100 cancer-related deaths annually.1 At diagnosis, 30% of patients have muscleinvasive disease, which is defined pathologically as organ confined (pT2), or extravesical disease (pT3 or pT4).2 In these patients, despite radical cystectomy (RC) and lymph node dissection only about 50% of patients are cured and most patients subsequently die of metastatic disease within 3 years of diagnosis. For MIBC patients treated with local therapy alone, the overall survival (OS) rates are 52% to 77% for pT2 disease, 40% to 64% for pT3 disease, and only 26% to 44% for pT4 or node-positive disease.3 Attempts to improve these outcomes have focused not only on improved surgical techniques and use of extended lymph node dissection, but also on the use of perioperative chemotherapy. All patients with suspected MIBC first require a transurethral resection of the bladder tumour (TURBT) with adequate muscle sampling to confirm the presence of muscle-invasion. Once confirmed, patients with MIBC should be considered for neoadjuvant chemotherapy (NC) which should begin as soon as possible after diagnosis. This recommendation is based on a large meta-analysis of 11 randomized trials of NC, which showed a 5% OS benefit with cisplatin-based combination regimens.4 Close follow-up (clinical and radiographic) during NC is crucial to monitor for toxicity and/or disease progression that may necessitate early discontinuation of NC and definitive local management. After NC is complete, and once blood counts are adequate, patients should undergo RC and lymph node dissection. For patients who are not surgical candidates, bladder sparing approaches may also be an option after NC; however, a comprehensive discussion of bladder preservation is beyond the scope of this article.Where NC is not an option, or if patients have already had definitive surgery adjuvant chemotherapy (AC) administered in a timely manner post surgery can be considered. The 2005 Advanced Bladder Cancer (ABC) meta-analysis systemically reviewed 6 adjuvant trials and though limited by small patient numbers and imbalances between patient groups, did show a 25% relative risk reduction in death. 5There was however, insufficient evidence to recommend AC over NC which remains the preferred option.Despite Level 1 evidence for NC, several studies including a Canadian survey of medical oncologists have shown

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Contemporary use of perioperative cisplatin‐based chemotherapy in patients with muscle‐invasive bladder cancer

Cited by 132 publications

References 50 publications

Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

Quality Indicators in the Management of Bladder Cancer

Neoadjuvant chemotherapy (NC) should be administered to fit patients with newly diagnosed, potentially resectable muscle-invasive urothelial cancer (MIUC) of the bladder – A 2013 CAGMO Consensus Statement and Call for a Streamlined Referral Process

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