Chemotherapy For Advanced Bladder Cancer Research Articles

Systemic Chemotherapy for Advanced Bladder Cancer: Update and Controversies

Despite improvements in surgical techniques and outcomes, 5-year survival rates for patients with muscle-invasive bladder cancer remain suboptimal. Almost 50% of patients will eventually progress and develop systemic disease. Although various single agents have shown activity in patients with advanced or metastatic disease, randomized trials have demonstrated the utility of cisplatin-based combinations regimens. Despite relatively high objective response rates, the impact on survival in patients with advanced disease has been quite limited. Surgical resection in selected patients achieving significant objective response to cytotoxic therapy can contribute to long-term survival rates. The role of salvage therapy in advanced disease remains undefined. Evaluation of several active compounds has yielded unimpressive results with low objective response rates and overlapping CIs. Recognition that the maximum benefit from conventional cytotoxics has been achieved has led to the recent initiation of a number of clinical trials evaluating targeted agents in the management of advanced urothelial cancer.

Bladder cancer

This article will review the diagnosis and management of bladder cancer at each stage, from superficial to metastatic disease with an emphasis on recent developments over the last year. Bacille Calmette-Guerin is the most effective therapy for carcinoma in situ. All patients who receive intravesical therapy with bacille Calmette-Guerin should be considered for ongoing maintenance therapy. The management of muscle invasive disease in the United States centers on radical cystectomy with bilateral pelvic lymphadenectomy. Areas of research include the optimal role for bladder preservation therapy, a growing experience in centers with laparoscopy, the effect of urinary diversion on quality of life, and the optimal standard for pelvic lymphadenectomy at surgery. The role of combination chemotherapy for advanced bladder cancer continues to evolve. Many questions remain unanswered including the relative value of neoadjuvant versus adjuvant chemotherapy for locally advanced disease and optimal chemotherapy regimen. The detection of bladder cancer continues to rely on direct visualization with cystoscopy. Efforts are underway to improve the utility of urinary markers and cystoscopy through fluorescence endoscopy. The management of superficial bladder cancer is based on transurethral resection of the tumor with perioperative intravesical instillation of chemotherapy strongly suggested for most patients. Risk stratifying patients with high-risk superficial bladder cancer remain a challenge and area of future research.

800 ORAL Molecular prognostic markers for survival after chemotherapy in advanced bladder cancer

800 ORAL Molecular prognostic markers for survival after chemotherapy in advanced bladder cancer

314: Gemcitabine Based Chemotherapy of Advanced Bladder Cancer in Elderly Patients-Investigations About the Influence of Age and Comorbidity on Therapy Caused Morbidity and Mortality

You have accessJournal of UrologyDiscussed Poster, Sunday, May 9, 2004, 8:00 am - 12:00 pm1 Apr 2004314: Gemcitabine Based Chemotherapy of Advanced Bladder Cancer in Elderly Patients-Investigations About the Influence of Age and Comorbidity on Therapy Caused Morbidity and Mortality Achim Elert, Carsten Ohlmann, Andres J. Schrader, Rainer Hofmann, and Axel Heidenreich Achim ElertAchim Elert More articles by this author , Carsten OhlmannCarsten Ohlmann More articles by this author , Andres J. SchraderAndres J. Schrader More articles by this author , Rainer HofmannRainer Hofmann More articles by this author , and Axel HeidenreichAxel Heidenreich More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37576-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "314: Gemcitabine Based Chemotherapy of Advanced Bladder Cancer in Elderly Patients-Investigations About the Influence of Age and Comorbidity on Therapy Caused Morbidity and Mortality." The Journal of Urology, 171(4S), pp. 82–83 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 82-83 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Achim Elert More articles by this author Carsten Ohlmann More articles by this author Andres J. Schrader More articles by this author Rainer Hofmann More articles by this author Axel Heidenreich More articles by this author Expand All Advertisement PDF downloadLoading ...

691 Gemcitabine based chemotherapy of advanced bladder cancer in elderly patients

691 Gemcitabine based chemotherapy of advanced bladder cancer in elderly patients

The present and future of combination chemotherapy in bladder cancer

The combination of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) has dominated the landscape of chemotherapy for advanced bladder cancer for over 15 years. Randomized studies have shown its superiority over cisplatin alone or in combination with cyclophosphamide and doxorubicin. However, it exhibits a significant toxicity profile and achieves only a slight impact on overall survival. Gemcitabine is among the new cytotoxic drugs in development for treatment of advanced urothelial cancer. The combination of gemcitabine and cisplatin represents a new standard alternative of treatment in the disease based on similar efficacy to and lower toxicity than the classic MVAC regimen. Future drug development will focus on the clinical usefulness of three-drug regimens (including gemcitabine, paclitaxel or docetaxel, and a platinum salt), and nonplatinum-based combinations, as well as showing the impact of adjuvant postcystectomy chemotherapy on survival. Semin Oncol 29 (suppl 9):32-39. Copyright 2002, Elsevier Science (USA). All rights reserved.

Advances in chemotherapy of invasive bladder cancer.

A survey of the literature published during 1999 identified the following advances in the chemotherapy of advanced bladder cancer. At present there are no new chemotherapy regimens superior to MTX + VBL + ADR + CDDP (M-VAC), but improvements in multidrug therapies and the development of new drugs suggest that a new first-line chemotherapy will be established. The efficacy of neoadjuvant chemotherapy could not be validated by meta-analysis, but neoadjuvant chemotherapy can be expected to be a useful tool for individualizing therapy. If it was possible to select accurately those patients who show complete response to a certain chemotherapy regimen, then this selected group would show a 100% complete response rate on that regimen, regardless of the complete response rate of this regimen in an unselected population. Such individualization of therapy would aid in future establishment of bladder-preserving treatment methods for invasive bladder cancers.

Original Articles: Bladder Cancer: Neoadjuvant Cisplatin Chemotherapy Before Radical Cystectomy in Invasive Transitional Cell Carcinoma of the Bladder: A Prospective Randomized Phase III Study

From November 1984 to April 1989, 122 patients with clinical T2-4a Nx-2 M0 transitional cell carcinoma of the bladder were entered in a prospective randomized trial to compare survival between a control group of 60 patients treated only with radical cystectomy (arm A) and a group of 62 patients treated with 3 cycles of 100 mg./m.2 neoadjuvant cisplatin before radical cystectomy (arm B). Secondary objectives of the trial were comparison of the disease-free interval and time to death, significance of response of the primary tumor to cisplatin, pattern of relapse and toxicity. As of April 1993 after a median followup of 78.2 months (range 48 to 101) no difference in survival between the control patients and those who received neoadjuvant cisplatin has been observed. The overall direct survival is 37.3% for arm A and 35.5% for arm B. The survival rate of the 109 patients who complied with the protocol is 38.2% for 55 patients of the control group and 40.7% for 54 patients of the cisplatin group. Survival rates of patients theoretically rendered free of disease by radical cystectomy (complete response pT0-4a, pN0-2, M0) is 43.7% for 40 control patients and 47.8% for 41 cisplatin treated patients. The time to relapse in complete response patients was significantly longer (p = 0.0298) for those who received cisplatin (arm A 13.1 months versus arm B 30.3 months). The time to death (cause specific) did not differ significantly between both groups overall (p = 0.1349) but it was significantly different between controls and responders (p = 0.0501). Preoperative cisplatin downstaged the primary tumor in 19 patients (33.9%), of whom 11 (19.6%) had no tumor in the cystectomy specimen (pT0) and 8 (14.3%) had superficial tumor (pTis pTa pT1). In 6 patients (9.7%) disease progressed during chemotherapy. The survival of the responders was significantly better than that of nonresponders (p = 0.0142), with specific death rate of 26.3% and 62.5%, respectively, and a median time to death of 43 months for responders and 30.5 months for nonresponders. Patients without nodal involvement (pN0) or with only 1 micrometastasis (pN1) fared significantly better (p = 0.0001) than those with major node invasion (pN2-4), irrespective of the treatment received. The survival rate is 48.6% for patients with pN0 disease, 37.5% for pN1 and 5% for pN2-4. Toxicity of cisplatin was minimal and there were no differences in perioperative morbidity between the arms.(ABSTRACT TRUNCATED AT 400 WORDS)

Chemotherapy for advanced bladder cancer: 'Midsummer Night's Dream' or 'Much Ado About Nothing'?

Chemotherapy for advanced bladder cancer: 'Midsummer Night's Dream' or 'Much Ado About Nothing'?

The chemotherapy of advanced bladder cancer.

This paper traces the development of the use of chemotherapy in the management of advanced bladder carcinoma in Europe. A number of agents, including cisplatin, methotrexate, vinblastine, adriamycin, fluorouracil and cyclophosphamide, have been investigated singly and in combination in phase II studies, and it is envisaged that an ideal combination chemotherapy regimen giving lasting complete response will ultimately be used along with limited ablative surgery in the management of localised advanced bladder cancer. Careful application of the increasing knowledge of the biology of transitional cell carcinoma and strict adherence to rigid criteria of response in the assessment of new agents appears at last to offer hope of an improvement in the prognosis of invasive bladder cancer.

Combination chemotherapy for advanced bladder cancer with adriamycin, cyclophosphamide, and 5-fluorouracil.

Combination three-drug chemotherapy with adriamycin (ADM), cyclophosphamide (CPM), and 5-fluorouracil (5-FU) was performed in 24 cases of advanced bladder cancer who underwent surgical treatment, and three cases with recurrent or metastatic bladder cancer. The average age (25 men and 2 women) was 53. Of the 24 cases, nine were in stage T2, 10 in T3, and five in T4. One course consisted of a combination of 30 mg/m2 of ADM, 300 mg/m2 of CPM, and, 250 mg of 5-FU, administered five times. The combination was administered to three groups: every day for 5 days consecutively in group A, twice a week for 21/2 weeks in group B, and once every 4 weeks for 16 weeks in group C. After injection of ADM, CPM, and 5-FU, 200 mg/day of 5-FU was administered PO daily in all three groups. The 5-year survival rate of the 24 cases (apart from 3 cases with measurable metastatic tumor) was 58%. The 5-year survival rate for stage T2 was 88%, and that for stage T3 was 62.5%; all patients with stage T4 disease died before 3 years and 6 months. Partial response was seen in two out of three patients with recurrent or metastatic disease. Alopecia was observed in all cases as a side-effect of the chemotherapy. Also anorexia, nausea, and myelosuppression were observed in many cases, though the degree was tolerable. However, there were no disorders of the cardiovascular system, except for one case with transient hypotension.

Transcatheter intraarterial infusion of chemotherapy in advanced bladder cancer.

Bilateral internal iliac artery infusion of chemotherapeutic agents in patients with advanced bladder carcinoma, Stage D, resulted in a 50% response or greater in nine of 15 patients with a median survival, thus far, of 52 weeks. Hematuria was controlled in eight of ten patients, and pain was relieved in 12 of 15 patients. Three additional patients were treated as adjuvants after their residual tumor was removed surgically or irradiated before chemotherapy. Cis-diamminedichloroplatinum (CDDP) was infused at a dose of 80--120 mg/m2 over a 24-hour period. When CDDP failed or in the presence of impaired renal function, a combination of 5-fluorouracil (5-FU) infused intraarterially while Adriamycin and mitomycin C were delivered intravenously, salvaged two patients. Complications were tolerable, consisting of transient acute tubular necrosis in two patients, a lower extremity embolus in one, and skin reactions due to 5-FU in two patients.

Combination chemotherapy for advanced bladder cancer.

Adriamycin, bleomycin, 5-fluorouracil and methotrexate have been used in combination in a Phase II study and as adjuvant chemotherapy for patients with locally advanced bladder cancer. Although early results with metastatic disease showed considerable antitumour activity, longer follow-up has shown this drug combination to be ineffective.

A trial of bleomycin versus adriamycin in advanced carcinoma of the bladder.

Thirty-seven patients were studied in a controlled clinical trial to assess the value of Adriamycin and Bleomycin in the treatment of advanced carcinoma of the bladder. The previously reported high response rates for both drugs were not observed in this trial. Administration of Bleomycin was accompanied by a toxicity rate so high that treatment had to be abandoned. Neither Adriamycin nor Bleomycin, therefore, used as single agents, have a role in the chemotherapy of advanced bladder cancer. Other agents should be investigated and assessed by controlled clinical trials that are disease-orientated rather than drug-orientated.