Invasive bladder cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Bellmunt, Joaquim; Albiol, Santiago; Kataja, Vesa

doi:10.1093/annonc/mdp136

Cited by 30 publications

(11 citation statements)

References 24 publications

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“…Accordingly, both the National Comprehensive Cancer Network and the European Society of Medical Oncology recommend either mvac or gc as first-line treatment in those patients 42,43 .…”

Section: 23mentioning

confidence: 99%

First- and Second-Line Therapy for Metastatic Urothelial Carcinoma of the Bladder

2011

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but little improvement has been achieved in the outcomes of patients with advanced or metastatic disease. Almost 90% of those patients eventually succumb to their cancer.For patients who relapse after first-line chemotherapy, the prognosis is generally poor. To date, there is no real consensus on how to best treat these patients, and most of the available evidence stems from small phase ii trials that have mostly failed to show survival benefit over supportive care. The present review provides an update on the management of metastatic bc, with a focus on first-line and secondline therapies. FIRST-LINE THERAPY Single-Agent TherapySingle-agent therapy has generally failed to provide adequate results in patients with advanced bc. In a phase iii trial of patients randomized to receive either cisplatin alone or in combination [methotrexate, vinblastine, doxorubicin, and cisplatin (mvac)], the overall response rate (or) was only 12% in the cisplatin arm, with only 4 of 122 patients (3.3%) remaining alive at 3 years of follow-up 4 . Similar results were observed in phase ii trials with carboplatin [or: 18%; median duration of survival (mds): 16 months] 5 . In a phase iii trial examining the role of lobaplatin, 2 of 17 patients (12%) achieved a partial response (pr), but the study was terminated because of high toxicity rates 6 . Other drugs investigated in phase ii trials have manifested variable activity against advanced urothelial cancer: oral piritrexim (or: 23%; mds: 22 weeks) 7 , trimetrexate (or: 17%; mds not reported) 8 , and docetaxel (or: 13%; mds: 9 months) 9 . However, some improved results were obtained with other single agents such as paclitaxel and gemcitabine 10,11 . In a phase ii trial of 26 patients with advanced bc treated with paclitaxel, the or was 42%, and the mds, 8.4 months 10 . Similarly, in a phase ii trial of gemcitabine in 40 patients, an or of 28% was reported, with a mds of 54 weeks 11 . ABSTRACTUrothelial cancer of the bladder is the 4th most common malignancy in American men and the 9th most common in women. Although it is a chemosensitive disease, advanced bladder cancer seems to have reached a plateau with regard to median survival of patients. Standard first-line therapy remains gemcitabine plus cisplatin (gc) or methotrexate, vinblastine, doxorubicin, and cisplatin (mvac). In patients deemed unfit to receive cisplatin, gemcitabine plus carboplatin or gemcitabine plus paclitaxel can be considered. To date, no standard therapy has been established for patients who recur or are refractory to first-line therapy. Second-line vinflunine, by way of superiority over best supportive care, has shown promise in a phase iii trial. Cisplatin-based therapy (mvac or gc) can also be offered to patients previously treated with cisplatin, especially if they responded previously and are considered platinum-sensitive. Novel targeted therapies are sorely needed to further improve the delivery and efficacy of chemotherapy.

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“…Accordingly, both the National Comprehensive Cancer Network and the European Society of Medical Oncology recommend either mvac or gc as first-line treatment in those patients 42,43 .…”

Section: 23mentioning

confidence: 99%

First- and Second-Line Therapy for Metastatic Urothelial Carcinoma of the Bladder

2011

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“…[2][3][4][5][6] Ambiguity in the impact and boundaries of a lymph node dissection at cystectomy likely explain the limited uptake of extended dissections (as measured by lymph node yields) in routine practice, 7 including variations in practice in higher-volume, academic centres. 8 There is consistent evidence that provider (hospital and surgeon) cystectomy volume is strongly associated with patient outcomes; [9][10][11] this evidence has led to calls for centralization of care for other complex surgical procedures.…”

mentioning

confidence: 99%

“…[3][4][5]15,16 Despite this, uptake of NACT in the general population is much lower than expected for the potential pool of appropriate candidates, perhaps dramatically so for those patients in Canada. 17 The same guidelines either do not support adjuvant chemotherapy (ACT), or provide only weak support, due to a lack of information from adequately powered RCTs.…”

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confidence: 99%

Delivering high-quality care to patients with muscle-invasive bladder cancer: Insights from routine practice in Ontario

Booth¹

2014

CUAJ

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“…Faute d'essais contrôlés à répartition aléatoire récents comparant systématiquement les résultats de la cystectomie radicale à ceux d'interventions moins agressives, les lignes directrices internationales sur les traitements définitifs localisés présentent des discordances [2][3][4][5][6] . L'ambiguïté qui plane sur l'incidence et les limites de la lymphadé-nectomie pendant la cystectomie explique sans doute le recours limité aux dissections élargies (mesurées selon le rendement ganglionnaire) dans la pratique courante 7 , et notamment l'écart par rapport à ce qui se fait dans les centres de santé universitaires à volume élevé 8 .…”

Section: L'auc a Pour Mandat De Promouvoir Les Plus Hautes Normes Danunclassified

Offrir des soins de qualité aux patients atteints d’un cancer invasif de la vessie : les leçons de la pratique clinique en Ontario

Booth¹

2014

CUAJ

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Invasive bladder cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Cited by 30 publications

References 24 publications

First- and Second-Line Therapy for Metastatic Urothelial Carcinoma of the Bladder

First- and Second-Line Therapy for Metastatic Urothelial Carcinoma of the Bladder

Delivering high-quality care to patients with muscle-invasive bladder cancer: Insights from routine practice in Ontario

Offrir des soins de qualité aux patients atteints d’un cancer invasif de la vessie : les leçons de la pratique clinique en Ontario

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