Bladder cancer progresses slowly from superficial bladder tumors causing bleeding but not a life threat to deeper invasion into the bladder muscular wall, where metastatic spread can occur. For years the standard treatment of invasive bladder cancer has been removal of the bladder (cystectomy). Within the last ten years further progress has been made with the use of chemotherapy either before or after removal of the bladder.
Recently researchers have wondered whether using simultaneous radiation to the bladder and chemotherapy could yield a good result. The chemotherapy used always contained cisplatin, a toxic and difficult drug to use in the patient population affected by bladder cancer — typically elderly with other health problems. A recent study published in the Journal of Clinical Oncology addresses this. Click here for the link. Dr. Stark can provide the entire article (he cannot post it here because of copyright protection) if you fill out out the form to the right of this page. The investigators, from Providence, RI, treated about sixty patients with either a cisplatin based treatment or gemcitabine, a less morbid drug. Patients received simultaneous radiation. If this approach did not eradicate the disease, bladder removal was recommended. At six years, 75% of each group were alive with an intact bladder and had no evidence of metastasis.
Dr. Stark comments: “This article not only shows that you don’t need to use cisplatin, it also calls into question whether you need to remove the bladder in most patients. These results are stunning; larger studies will be needed in followup. Newer drugs, specifically checkpoint inhibitors, should result in even better outcomes.”