Chemotherapy for bladder cancer: A United Kingdom practice survey

Abstract

16078 Background: Chemotherapy has an established role in the treatment of locally advanced (LABC) and metastatic bladder cancer (MBC). Chemotherapy regimens vary, in particular, there is no agreed standard of care for second line treatment of metastatic disease. To aid future study design, we conducted a current practice survey. Methods: A written questionnaire was mailed to 110 UK urological oncologists requesting anonymous replies in pre-paid envelopes. Results: Of the 61 questionnaires returned, 8 denied treating bladder cancer. These were excluded from further analyses. In first line MBC, 45/53 [85%] preferred gemcitabine/cisplatin (GC), with considerable variation in schedule. Methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) was the next preferred regimen (7/53[13%]). In patients unsuitable for cisplatin, 39/51 [76%] reported using gemcitabine/carboplatin (GCarbo). Other options were gemcitabine alone (5/51[10%]) and methotrexate/carboplatin/vinblastine (CMV) (2/51[4%]). In second line MBC, 10/43 [23%] respondents reported using GC, 7/43 [16%] used GCarbo, 6/43 [14%] used paclitaxel/carboplatin (PC) and 6/43 [14%] used MVAC. In the absence of formulary restrictions, 16/34 [47%] clinicians would choose paclitaxel alone or in combination with platinum as their preferred choice of second line regimen. 25/26 [96%] clinicians reported 3 weekly PC as an acceptable control arm for a randomised controlled trial of second line chemotherapy. The most popular neoadjuvant regimen for LABC was GC (42/49[86%]). 4/49 [8%] of clinicians used MVAC based regimens. In the adjuvant setting, 29/34 [85%] clinicians chose GC and the remainder CMV or MVAC. Conclusions: In UK clinical practice, chemotherapy treatment of bladder cancer is largely uniform. Standard of care for neoadjuvant, adjuvant and 1st line for MBC consists of gemcitabine/platinum doublet. Second line treatment of MBC, however, is more variable and this is an area which needs further clinical study. These data will inform the design of future trials in treatment of MBC. No significant financial relationships to disclose.