Adjuvant chemotherapy 'essential' to bladder cancer treatment

Chicago-Adjuvant chemotherapy is an essential part of the treatment protocol for lymph node-positive bladder cancer, results of a retrospective study of patients seen at the University of Chicago suggest.

Looking back at 67 node-positive patients who underwent radical cystectomy between 1995 and 2005, those who also had combined adjuvant chemotherapy fared significantly better in both disease-free and overall survival, researchers reported at the 2008 AUA annual meeting in Orlando, FL.

"The differences in disease-free and overall survival were so remarkable that we believe these data are sufficient to use in counseling patients," said senior author Gary D. Steinberg, MD, professor and vice chair of urology.

All patients had lymph node-positive bladder cancer (26 with stage pN1, 41 with stage pN2). Following surgery, 35 of the 67 (52%) agreed to chemotherapy. Most (28) received a combination of gemcitabine (Gemzar) and cisplatin (Platinol); the others received alternate combinations. Thirty-two declined further treatment.

Dr. Steinberg said the relative ratio between those who accepted chemotherapy and those who declined it closely mirrors what he and others see in real-life clinical practice.

"Many patients recovering from major surgery decline any further treatments without proof that it may prolong their life," Dr. Steinberg explained.

Indeed, while node-positive bladder cancer is a systemic disease, and it would seem reasonable that adjuvant chemotherapy, administered when tumor burden is low, might prolong survival, nothing in the literature was available to prove that assumption.

The two groups in the study were fairly similar in postoperative complication rate and N stage, although deferring patients were on average 5 years older and had a more advanced T stage. Chemotherapy was well tolerated among those who accepted it, with 28 of 35 patients (80%) completing all four cycles.

The median overall survival for patients given adjuvant chemotherapy was 48 months, compared with just 8 months for those who declined (p<.0001). Further, multivariate analysis suggested that adjuvant chemotherapy was an independent factor directly affecting overall survival (hazard ratio 0.2, p<.0001). Disease-free survival was 34 months for the adjuvant chemotherapy group and 6 months for those who deferred (p<.0001).

The authors noted that future studies are required to determine the most appropriate timing for chemotherapy in lymph node-positive bladder cancer.