Effectiveness of Adjuvant Chemotherapy for Locally Advanced Bladder Cancer

Galsky, Matthew D.; Stensland, Kristian; Moshier, Erin; Sfakianos, John P.; McBride, Russell; Tsao, Che‐Kai; Casey, Martin F.; Boffetta, Paolo; Oh, William; Mazumdar, Madhu; Wisnivesky, Juan P.

doi:10.1200/jco.2015.64.1076

Cited by 169 publications

(88 citation statements)

References 33 publications

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“…29 An observational study evaluated 5,653 patients, of which 23% received adjuvant chemotherapy after cystectomy. 28 Patients who received adjuvant chemotherapy had an improved OS (HR, 0.70; 95% CI, 0.06-0.76). 28 Although evidence for adjuvant therapy is not as strong as for neoadjuvant therapy, the growing body of data support the administration of adjuvant chemotherapy for patients with a high risk for relapse who did not receive neoadjuvant therapy.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

“…Studies have shown that adjuvant chemotherapy may delay recurrences and improve OS, [27][28][29] but no randomized comparisons of adequate sample size have definitively shown a survival benefit, in large part due to poor accrual. 30 Clinical trials of adjuvant chemotherapy with cyclophosphamide, doxorubicin, and cisplatin (CAP); MVAC; and methotrexate, vinblastine, epirubicin, and cisplatin (MVEC) regimens have each suggested a survival advantage.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

“…• Ifosfamide, doxorubicin, and gemcitabine 16 • Gemcitabine and paclitaxel 15 • Gemcitabine and cisplatin 4 • DDMVAC • Cisplatin a and paclitaxel 28,29 • 5-FU and mitomycin 30 • Cisplatin a alone 31…”

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confidence: 99%

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Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Spiess¹,

Agarwal²,

Bangs³

et al. 2017

J Natl Compr Canc Netw

225

173

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OverviewAn estimated 79,030 new cases of urinary bladder cancer (60,490 men and 18,540 women) will be diagnosed in the United States in 2017 and approximately 16,870 deaths (12,240 men and 4630 women) will occur. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines Disclosures for the NCCN Bladder Cancer PanelAt the beginning of each NCCN Guidelines panel meeting, panel members review all potential conflicts of interest. NCCN, in keeping with its commitment to public transparency, publishes these disclosures for panel members, staff, and NCCN itself.Individual disclosures for the NCCN Bladder Cancer Panel members can be found on page 1267 (The most recent version of these guidelines and accompanying disclosures are available on the NCCN Web site at NCCN.org.)These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Section: Adjuvant Chemotherapymentioning

confidence: 99%

Section: Adjuvant Chemotherapymentioning

confidence: 99%

See 1 more Smart Citation

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Spiess¹,

Agarwal²,

Bangs³

et al. 2017

J Natl Compr Canc Netw

225

173

View full text Add to dashboard Cite

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“…The results found an improvement in OS with the use of adjuvant chemotherapy compared with RC alone (HR: 0.77; 95% CI: 0.59-0.99; p = 0.049), as well as an improvement in disease-free survival (DFS; HR: 0.66; 95% CI: 0.45-0.91) that was weighted toward the patients with node-positive disease (p = 0.010). More recently, Galsky and colleagues published their findings of a meticulous observational study of 'real-world' patients receiving adjuvant chemotherapy for high-risk MIBC, defined as pT3-4 and/or pathologically node positive [34]. Data from the National Cancer Data Base (NCDB) were used to compare OS for 5653 patients receiving adjuvant chemotherapy (23% of total) versus observation after curative-intent surgery.…”

Section: • Adjuvant Chemotherapymentioning

confidence: 99%

Systemic Therapy for Bladder Cancer Finally Comes into a New Age

Zibelman

Plimack

2016

Future Oncol.

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Systemic therapy for bladder cancer, both localized muscle-invasive disease and metastatic disease, has seen minimal progress over the past two decades. Current approaches rely upon cytotoxic chemotherapy combinations aimed at increasing cure rates or achieving palliation and disease control, but these regimens are fraught with short-and long-term toxicities and outcomes remain suboptimal. The emergence of systemic immunotherapies that can provide durable remissions in subsets of patients with other malignancies has the potential to transform the field, and early phase trials have begun to demonstrate activity in some patients with metastatic bladder cancer. In this article, we review the current state of systemic therapy for bladder cancer and discuss the current literature and ongoing trials utilizing various immunotherapies. KEYWORDS• bladder cancerCancers of the urinary bladder are the sixth most commonly diagnosed malignancy in the USA and the most prevalent malignancy of the GI tract, with 74,000 new cases estimated from 2015 [1]. The predominant histologic subtype is urothelial carcinoma (UC), which accounts for more than 90% of diagnoses in the western world. For patients with muscle-invasive bladder cancer (MIBC) confined to the bladder and deemed surgical candidates, radical cystectomy (RC) with pelvic lymphadenectomy remains the gold standard, with bladder preservation techniques using combinations of radiation therapy (RT) and systemic therapy receiving increased attention [2][3][4][5]. Local therapy with surgery or radiation alone is suboptimal, with median overall survival (OS) ranging from 1.8 to 3.8 years and 5-year survival of only 43% after RC and less than 40% with RT, with the majority of deaths related to distant disease [6,7]. The addition of neoadjuvant chemotherapy (NAC) has significantly improved outcomes. For patients who present with metastatic disease, systemic chemotherapy with cisplatin-based regimens, long recognized as an active drug in this disease, is accepted as the standard of care. Thus, systemic therapy is an integral component of treatment for patients with UC, yet despite tremendous advances across a multitude of malignant conditions, no new therapies have entered the armamentarium in over decade. Fortunately, recent and ongoing research in the burgeoning field of cancer immunotherapy (IT) offers hope that new agents will finally demonstrate survival benefits in clinical trials. In this article, we review the definitive studies that have established the current standards of care for systemic treatment in UC, then focus on new and future trials aiming to bring the systemic treatment of UC into the IT age.For reprint orders, please contact: reprints@futuremedicine.com

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“…[2][3][4] Clinical trials exploring adjuvant chemotherapy have been flawed and/or underpowered, but accumulating evidence also supports an improvement in outcomes with this approach. [5][6][7] Unfortunately, once bladder cancer has visibly metastasized to distant sites, although systemic chemotherapy may impart therapeutic benefit, patients rarely achieve cure, and median survival is only approximately 14 months. 8 The standard management of patients with clinically localized and distant metastatic bladder cancer has been defined through a series of prospective randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Treatment Strategies for Bladder Cancer With Clinical Evidence of Regional Lymph Node Involvement

Galsky

Stensland

Sfakianos

et al. 2016

JCO

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Purpose Patients with bladder cancer with clinical lymph node involvement (cN+) are at high risk for distant metastases, but are potentially curable. Such patients are excluded from neoadjuvant chemotherapy trials and pooled with patients with distant metastases in first-line chemotherapy trials not suited to define the role of combined-modality therapy. To address this evidence void, we performed a comparative effectiveness analysis. Methods We included cTanyN1-3M0 bladder cancer patients from the National Cancer Data Base (2003-2012) treated with chemotherapy and/or cystectomy. We used multistate survival analysis, allowing for delayed entry, to assess overall survival (OS) according to various treatment strategies. Effectiveness was estimated with multivariable adjustment for tumor-, patient-, and facility-level characteristics. Results Among 1,739 patients (cN1, 48%; cN2, 45%; cN3, 7%), 1,104 underwent cystectomy and 635 were treated with chemotherapy alone. Of the cystectomy patients, 363 received preoperative and 328 received adjuvant chemotherapy. The crude 5-year OS for chemotherapy alone, cystectomy alone, preoperative chemotherapy followed by cystectomy, and cystectomy followed by adjuvant chemotherapy was 14% (95% CI, 11% to 17%), 19% (95% CI, 15% to 24%), 31% (95% CI, 25% to 38%), and 26% (95% CI, 21% to 34%), respectively. Compared with cystectomy alone, preoperative chemotherapy was associated with a significant improvement in OS (hazard ratio, 0.80; 95% CI, 0.66 to 0.97). Adjuvant chemotherapy was also associated with a significant improvement in survival compared with cystectomy alone. The survival of patients treated with chemotherapy alone was worse than those treated with cystectomy alone. Conclusion A subset of patients with cN+ bladder cancer achieves long-term survival. Combined-modality therapy, with chemotherapy and cystectomy, is associated with the best outcomes.

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Effectiveness of Adjuvant Chemotherapy for Locally Advanced Bladder Cancer

Cited by 169 publications

References 33 publications

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Systemic Therapy for Bladder Cancer Finally Comes into a New Age

Comparative Effectiveness of Treatment Strategies for Bladder Cancer With Clinical Evidence of Regional Lymph Node Involvement

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