scholarly journals Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

2014 ◽  
Vol 8 (9-10) ◽  
pp. 309 ◽  
Author(s):  
Tina Hsu ◽  
Peter C Black ◽  
Kim N Chi ◽  
Christina M Canil ◽  
Bernie J Eigl ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Renal Function ◽  
Performance Status ◽  
Standard Of Care ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Urologic Oncology ◽  
Canadian Association ◽  
Medical Oncologists ◽  
Muscle Invasive

Introduction: Uptake of neoadjuvant chemotherapy (NC) for muscle-invasive bladder cancer (MIBC) has been low despite evidence of a survival benefit. The primary aim of this study was to better understand why the rates are low and determine what factors specifically influence the decision to recommend NC for MIBC.Methods: A 31-question survey was emailed between 2009 and 2011 to medical oncologists belonging to the Canadian Association of Genitourinary Medical Oncologists (CAGMO); and to urologists belonging to the Canadian Urologic Oncology Group (CUOG). We gathered data on practice characteristics, referrals for NC, factors influencing NC use, and chemotherapy regimens offered. Responses were summarized using descriptive statistics.Results: In total, 26/30 (87%) medical oncologists and 25/84 (30%) urologists, who were primarily academic, completed the survey. Most clinicians (medical oncologists 96%, urologists 88%) recommended NC for MIBC, because they considered it to be the standard of care, but most medical oncologists saw ≤6 referrals annually. Performance status, presence of comorbidities and renal function were key considerations in offering NC. NC was not offered if performance status ≥2 (medical oncologists 38%, urologists 44%), age >80 (medical oncologists 46%, urologists 39%), or glomerular filtration rate ≤40 mL/min (medical oncologists 81%, urologists 50%).Conclusions: Most academic clinicians in Canada believe that cisplatin-based combination NC is the standard of care for MIBC and recommend it for patients with adequate performance status and renal function. Using a multidisciplinary approach to treat this disease may be one strategy to increase referral rates for NC and uptake of NC.

The neoadjuvant management of muscle-invasive bladder cancer (MIBC) in Canada: A national survey of urologists.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 303-303 ◽  
Author(s):  
Srikala S. Sridhar ◽  
Kim N. Chi ◽  
Scott A. North ◽  
Peter C. Black ◽  
Lori Wood ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Renal Function ◽  
Medical Oncology ◽  
Performance Status ◽  
Standard Of Care ◽  
Full Time ◽  
Urologic Oncology ◽  
Poor Renal Function ◽  
Medical Oncologists ◽  
Muscle Invasive

303 Background: There is level 1 evidence and a 5% absolute survival benefit supporting the use of cisplatin-based neoadjuvant chemotherapy (NC) for the management of MIBC. Despite this, it is well known that the majority of eligible patients undergoing cystectomy do not receive NC. We previously surveyed medical oncologists and found that the majority will offer NC to MIBC patients depending on stage, renal function, performance status (PS), and comorbidities. However, the number of MIBC patients being referred for consideration of NC by urologists remains low. The aim of this followup survey to urologists was to better understand their approach to MIBC, and referral patterns for NC. Methods: A survey consisting of 24 questions was administered to Canadian urologists belonging to the Canadian Urologic Oncology Group. Respondents completed the survey and mailed/faxed back their responses. The survey was similar to, but not identical to the previous medical oncology survey. Results: Of the 25 respondents, 21/25 (84%) were academic, >90% were in full-time practice, and 72% were practising for >10 yrs. Most (84%) treated over 20 bladder cancer cases annually. Overall, 22/25 (80%) will offer a NC approach if appropriate. In 2009, 9/24 (38%) sent >6 referrals for NC; 2/24 (25%) sent 5-6 referrals, 6/24 (20%) sent 3-4 referrals, and 5/24 (8%) sent 1-2 referrals. NC was offered as standard of care or to downsize tumors. Initial staging included cystoscopy, CT chest/abdo/pelvis and bone scan. Key factors cited for not offering NC were: T2a disease, GFR <40ml/min, age >85 or PS 3 or 4. Average time from NC to cystectomy was 4-6 wks. Conclusions: The majority of academic urologists in Canada will refer MIBC patients for NC except those with T2a disease, poor renal function, age >85 or poor PS. Non-academic urologists are underrepresented in this survey, and may represent the group facing the greatest challenges in offering NC, due to issues such as access to medical oncology, or lack of local expertise in managing MIBC. Targeting non-academic urologists, and encouraging consultation with a medical oncologist for all patients with MIBC, may lead to increased utilization of NC, and better outcomes in this disease.

Outcome of BC2001 patients (CRUK/01/004) who received neoadjuvant chemotherapy prior to randomization to chemo-radiotherapy (cRT) versus radiotherapy (RT).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 298-298 ◽  
Author(s):  
Syed A. Hussain ◽  
Emma Hall ◽  
Nuria Porta ◽  
Malcolm Crundwell ◽  
Peter Jenkins ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Performance Status ◽  
Neoadjuvant Treatment ◽  
Late Toxicity ◽  
Invasive Bladder Cancer ◽  
P Value ◽  
Muscle Invasive Bladder Cancer ◽  
Cox Models ◽  
Muscle Invasive

298 Background: Neoadjuvant chemotherapy is considered standard of care for patients with muscle invasive bladder cancer (MIBC). Gemcitabine plus cisplatin or carboplatin (GC) has been adopted as a standard neoadjuvant regimen for MIBC. BC2001 showed that adding chemotherapy (5FU+MMC) to radiotherapy (55Gy/20f or 64Gy/32f) significantly improved rates of muscle invasive bladder cancer (MIBC) locoregional control (LRC) [James 2012]. We report outcome of patients (pts) receiving neoadjuvant chemotherapy prior to starting BC2001 trial treatment (cRT or RT alone). Methods: Between August 2001 and April 2008, 360 pts were randomised to RT (178) or cRT (182); 117 (32.5%) received neoadjuvant chemotherapy (61 RT, 56 cRT). Primary endpoint was LRC, secondary endpoints included toxicity, overall survival (OS) and metastasis free survival (MFS). Cox models adjusted by known prognostic factors were used to estimate randomised treatment effect in this subgroup of pts. Toxicities were compared by Chi squared tests. Results: Median age of the 117 pts was 66 (interquartile range: 60-73) years, 86% were male, 73% had baseline 0 WHO performance status. 81% had T2 and 87% G3 tumours. Neoadjuvant treatment received was GC (73.5%), MVAC (13.6%), CMV (11.1%) or other (<2%). 92.3% cRT and 91.8% RT pts completed radiotherapy as planned. Grade 3 or above adverse events during treatment occurred in 27.4% pts (32.2% cRT vs 22.9 RT, p-value(p)=0.27), and in 9.5% during follow-up (13.4% cRT vs 5.3% RT, p=0.21). There was a trend for improved LRC in the cRT group (hazard ratio HR=0.64, 95CI% 0.33-1.23, p=0.18), while no differences in OS (HR=0.95, 95CI% 0.57-1.57, p=0.83) or MFS (HR=0.93, 95CI% 0.52-1.65, p=0.80) were observed. Median OS was 46.7 months ,cRT: 50.4 months vs RT: 46.7 months. MFS: Median: 68.5 months, cRT: 118.5 months vs RT: 54.2 months. Conclusions: The benefit in improved LRC of synchronous chemotherapy with 5FU/MMC was also found in the subgroup of BC2001 pts receiving neoadjuvant chemotherapy, with no significant increase in late toxicity. Neoadjuvant chemotherapy did not compromise the delivery of radical curative treatment with RT or cRT. Clinical trial information: ISRCTN68324339.

Trend in the use of neo-adjuvant chemotherapy for the management of muscle invasive bladder cancer at a major tertiary care hospital in Pakistan.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16033-e16033
Author(s):  
Adnan Abdul Jabbar ◽  
Muhammad Asad Maqbool ◽  
Muhammad Bilal Mirza
Keyword(s):  
Bladder Cancer ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Invasive Bladder Cancer ◽  
Care Hospital ◽  
Muscle Invasive Bladder Cancer ◽  
Middle Income ◽  
Middle Income Countries ◽  
Muscle Invasive

e16033 Background: Although the use of Neoadjuvant Chemotherapy (NAC) has now become the standard of care for Muscle Invasive Bladder Cancer (MIBC) in the world, most patients in lower- middle-income countries (LMIC), like Pakistan, are still undergoing upfront surgery despite being ideal candidates for chemotherapy. Multi-disciplinary tumor boards have been critical in the change of this trend in the developed world. We aimed to assess the trends in the use of NAC for patients with muscle invasive bladder cancer before undergoing definitive surgery. Methods: We included patients who underwent surgery for ≥ cT2 MIBC without distant metastasis between 2011 and 2015 at a tertiary care hospital in Karachi, Pakistan. We retrospectively assessed the trends in NAC compared to upfront surgery in these patients. Results: Among the 171 patients included in our study, only 4 (2.34%) received NAC, whereas the other 167 (97.67%) underwent upfront surgery without NAC. Out of the 90 patients who underwent surgery for MIBC between 2011 and 2013, none of them received NAC and underwent upfront surgery. Among the 81 patients with MIBC in 2014 and 2015, 4 patients received NAC before surgery whereas the other 77 underwent upfront surgery. Conclusions: The adoption of NAC for MIBC remains a challenge in lower- middle-income countries such as Pakistan. Introduction of a multidisciplinary tumor board in our hospital since 2014 has shown a slight change in this trend. Better communication between different departments remains the key in significantly changing the trend of a much desired standard of care.

Neoadjuvant chemotherapy for muscle-invasive bladder cancer: Dana-Farber Cancer Institute (DFCI) experience.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16037-e16037
Author(s):  
Catherine Curran ◽  
Archana Agarwal ◽  
Amin Nassar ◽  
Sarah Abou Alaiwi ◽  
Vivek Kumar ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Renal Function ◽  
Neoadjuvant Chemotherapy ◽  
Pathologic Complete Response ◽  
Cox Proportional Hazards ◽  
Invasive Bladder Cancer ◽  
Early Discontinuation ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
The Impact

e16037 Background: Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) extends overall survival in muscle invasive bladder cancer (MIBC) patients (pts) and pathologic complete response (pCR) is associated with improved survival. We conducted a retrospective study at DFCI to examine the impact of different chemotherapy regimens and renal function on pCR and tolerability. Methods: Pts who underwent RC for MIBC were retrospectively studied. Descriptive statistics were calculated, and univariable Cox proportional hazards regression analysis was conducted to examine the prognostic effect of candidate factors (age, gender, chemotherapy regimen, creatinine clearance [Cr Cl] by Cockroft Gault formula) on pCR (ypT0), < ypT2N0 rate and early discontinuation for toxicities. Results: 196 patients treated with NAC were identified from 2002 -2018 (Table). Unconventional regimens (split dose cisplatin or carboplatin combined with gemcitabine) exhibited lower pCR rate (14%), but a moderate < ypT2N0 rate (36%). Among those receiving conventional cisplatin-based regimens, we did not identify an association between renal function (Cr Cl < 60 vs. ≥60 ml/min), age, gender and specific regimen (Cisplatin/Gemcitabine, MVAC, ddMVAC) with pCR or early discontinuation ( < 4 cycles) for toxicities, although the < ypT2N0 rate was numerically higher for MVAC/ddMVAC. The modest size of this cohort limited the analysis. Conclusions: pCR rates were similar with ddMVAC/MVAC and GC for MIBC, with potential superiority of MVAC/ddMVAC to GC for a subset of pts. If Cr Cl ≥50 ml/min, it may be reasonable to consider conventional cisplatin therapies as non-conventional NAC appeared to yield lower depth of benefit emphasizing need for evaluation of new tolerable regimens. [Table: see text]

A phase I/II feasibility study of cetuximab with 5FU and mitomycin C or cisplatin with concurrent radiotherapy in muscle invasive bladder cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 491-491
Author(s):  
Nicholas D. James ◽  
Sarah Pirrie ◽  
Wenyu Liu ◽  
Daniel Ford ◽  
Anjali Zarkar ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Mitomycin C ◽  
Phase 1 ◽  
Performance Status ◽  
Invasive Bladder Cancer ◽  
Phase 2 ◽  
Muscle Invasive Bladder Cancer ◽  
Free Survival ◽  
Patient Reported ◽  
Muscle Invasive

491 Background: Chemoradiotherapy (cRT) with 5FU and Mitomycin C (5FU/MMC) is an accepted standard of care for muscle invasive bladder cancer. Cetuximab is an approved radio-sensitiser in head and neck cancer and EGFR is over-expressed in bladder cancer. We report a phase 1/2 trial of the addition of cetuximab to standard cRT. Methods: Phase 1/2 single-arm, multicentre, open-label study conducted in 5 UK centres. Treatment: RT: 64 Gy/32 fractions, 5FU 2.5g/m2 over days 1-5 & 22-26, MMC 12g/m2 day 1, cetuximab 400mg/m2 day -8, 200mg/m2 day 1 and weekly x7. Main inclusion criteria: T2-4aN0M0 urothelial cancer, PS 0-1; prior neoadjuvant therapy permitted. Endpoints: Phase 1; feasibility and safety of cRT with cetuximab + 5FU/MMC in combination. Phase 2; local control (LC) at 3 months. Secondary outcomes: invasive loco-regional progression free survival (LPFS), noninvasive LPFS, metastasis free survival (MFS), overall survival (OS) & patient reported outcomes (PROMs). Sample size; phase 1 between 6 and 18, phase 2 up to 45 including those recruited in phase 1. Results: Between Sept 2012 and Oct 2016, 33 patients were recruited; 7 in phase 1 26 in phase 2. Median age 70.1 (IQR 65.4-80.2) yrs, 60.6% WHO Performance Status 0; 81.8% male, 26/33 neoAd chemotherapy. 3 patients ineligible post registration. 30 evaluable pts started RT, 1 patient didn’t complete RT due to serious adverse event (interstitial pneumonitis), 3 with delays. Phase 1, 6/7 pts completed Cetux therapy, 1 omitted 1 dose for grade 3 rash. LC was 77% (95% CI 58, 90). Overall median dose intensities Cetux 100%, MMC 99% 5FU 99.8%. 8 pts developed recurrence; 2 MIBC. The 6 & 12 month muscle-invasive LPFS was 93 &; non-invasive LPFS 97% & 85%, MFS 90% & 90%, OS 97% & 87%. PROMs showed a transient dip at 1 mo, back to baseline at 3 mo. Conclusions: Phase 1 data demonstrate it’s feasible and safe to add cetuximab to cRT with 5FU/MMC with high delivered dose intensities. Although recruitment failed to reach the pre-specified target for phase 2 exploratory analysis indicate the 3 month bladder control rates and recurrence rates are above those reported in BC2001 with good PROMs provides evidence to consider further evaluation of cetuximab. Clinical trial information: 80733590.

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