Effective and less toxic trimodality approach in muscle invasive urinary bladder cancer.

Abstract

e15505 Background: Bladder cancer represents a global health problem. Radical cystectomy considered the standard of care for invasive bladder cancer. Because of the potential morbidity with surgery, organ preservation via trimodality approach has been the subject of investigation. The concurrent use of cisplatin with 5-FU or gemcitabin with local radiotherapy has been studied and the results were better than radical cystectomy. However, this was associated with grade 3-4 (G3-4) toxicity. Recently, similarly effective but less toxic regimen by the use of paclitaxel and cisplatin is under investigation. Methods: We proposed a single-center, single arm, phase II prospective cohort study. 30 patients (22 male and 8 female) with T2-T3 bladder cancer according to the AJCC 2010 were included. All patients were >18y with exclusion of those with bladder capacity < 350cc, hydronephrosis, with previous intravesical therapy, systemic chemotherapy or pelvic radiation, those currently receiving nephrotoxic or ototoxic drugs, and those with other malignancies. All patients treated with maximum transurethral resection (TUR) followed by local radiotherapy 64Gy concurrently with weekly 60mg/m2 Paclitaxel and 20mg/m2 Cisplatin. Results: Cystoscopic re-evaluation 6-8 weeks after the end of treatment revealed that 90% of patients achieve complete response (CR), 6.7% achieve partial response (PR) and 3.3% had stable disease (SD). Mild toxicity was infrequent and easily controlled without interruption of treatment except in one patient. Toxicity was in the form of cystitis G1 in 46.7% and G2 in 3.3%. Diarrhea G1 in 33.3% and G2 in 3.3%. Only one patient who has past history of piles, developed G2 proctitis that leads to irregularity of treatment. Other mild toxicities were: G1 dermatitis (80%), G1 bleeding per rectum (3.3%), G1 anemia (13.3%), G1 and G2 nausea and vomiting (50% and 33.3% respectively), while neutropenia and thrompocytopenia were not seen. Conclusions: Our preliminary results revealed that weekly low dose paclitaxel and cisplatin concurrently with local radiotherapy was effective, tolerable and has acceptable toxicity in the treatment of muscle invasive urinary bladder cancer.