Cancer Treatment Today » Bladder Cancer

Medicaid on CT surveillance of bladder cancer after radical cystectomy – pro

M Levin, MD — Sun, 15 Dec 2013 17:11:56 +0000

CMS requires that the CT scan be reasonable and necessary based on the literature and opinion. Reasonableness and opinion is expressed by guidelines,

After radical cystectomy, NCCN recommends:

Urine cytology, liver function tests, creatinine, and electrolytes every 3 to 6 mo for 2 y and then as clinically indicated
Imaging of the chest, upper tracts, abdomen, and pelvis every 3 to 6 mo for 2 y based on risk of recurrence and then as clinically indicated
Urethral wash cytology every 6 to 12 mo, particularly if Tis was found within the bladder or prostatic urethra
If a continent diversion was created, monitor for vitamin B12 deficiency annually.

ACR has similar recommendations: CT is recommended at 6, 12, and 24 months for follow-up of patients with minimal muscle invasion (T2) who elect either cystectomy or other types of therapy without cystectomy, since most recurrences become evident within the first 2 years after surgery.

NCCN, BLadder Cancer, BL-E, 2013

CMS Guidelines National Coverage Determination (NCD) Computed Tomography (220.1)
2013

Leyendecker JR, Francis IR, Casalino DD, Arellano RS, Baumgarten DA, Curry NS, Dighe M, Fulgham P, Israel GM, Papanicolaou N, Prasad S, Ramchandani P, Remer EM, Sheth S, Expert Panel on Urologic Imaging. ACR Appropriateness Criteria follow-up imaging of bladder carcinoma. [online publication]. Reston (VA): American College of Radiology (ACR); 2009. 10 p. [80 references]

NMP-22 urine assays for bladder cancer – pro

M Levin, MD — Fri, 21 Dec 2012 17:53:42 +0000

NMP-22 urine assays for bladder cancer detect nuclear mitotic apparatus protein 1 (NUMA-1) using monoclonal antibodies. NMP-22 protein provides structural support for the nucleus and ensures the correct separation of genetic material during mitosis into the respective daughter cells through mitotic spindle stabilization. It is not a particularly specific tests, with many described non-cancer factors that elevate its values, and there is ongoing controversy as to whether its advantages in sensitivity over urine cytology are sufficient to recommend it as a routine screening test for bladder cancer.

Medicare has granted this test a CLIA exception but there are no guidelines that support its use at this time.

Huber S, Schwentner C, Taeger D, Pesch B, Nasterlack M, Leng G, Mayer T, Gawrych K, Bonberg N,

Pelster M, Johnen G, Bontrup H, Wellhäußer H, Bierfreund HG, Wiens C, Bayer C, Eberle F,

Scheuermann B, Kluckert M, Feil G, Brüning T, Stenzl A: UroScreen Study Group. Nuclear matrix protein-22: a prospective evaluation in a population at risk for bladder cancer. Results from the UroScreen study. BJU Int 2012, 110(5):699-708

Todenhöfer T, Hennenlotter J, Witstruk M, Gakis G, Aufderklamm S, Kuehs U, Stenzl A, Schwentner C: Influence of renal excretory function on the performance of urine based markers to detect bladder cancer. J Urol 2012, 187(1):68-73.

For Lay version see here

Intravesicular interferon after transurethral resection of non-muscle invasive bladder cancer – pro

M Levin, MD — Fri, 26 Oct 2012 17:53:20 +0000

Standard adjuvant therapy for non muscle invasive cancer can reduce the risk of recurrence. Patients at high risk for cancer recurrence receive bacillus Calmette-Guérin (BCG) therapy after surgery. One study that compared mitomycin with interferon alfa-2b showed an improved outcome with mitomycin, although interferon was better tolerated. Intravesical interferon therapy with BCGT or by itself can significantly lower the recurrence rate in superficial bladder cancer. In vitro evidence suggested that IFN combined with BCG may have a synergistic effect on the immune response, and treatment regimens with IFN have used reduced BCG dosage in an attempt to reduce toxicity.

Evidence supporting interferon is limited. NCCN recommends mitomycin or BCG. 2013 ALberta guideline says: “Maintenance therapy BCG with alpha-2b interferon is indicated if the patient is disease free at first cystoscopy; dosage as prescribed in the pre-written orders available from Cancer Care pharmacies.” Lsmm et al says: “BCG and IFN-α combination intravesical therapy has not been investigated thoroughly; based on available data, combination therapy appears to be most effective in patients with carcinoma in situ and may be preferentially considered as an alternative to radical cystectomy for patients with intermediate-risk or high-risk NMIBC who do not tolerate the standard BCG dose or experience BCG failure after 1 year of therapy. ”

Lamm D Brausi M, O’Donnell MA, Witjes JA. Interferon alfa in the treatment paradigm for non-muscle-invasive bladder cancer.Urol Oncol. 2014 Jan;32(1):35.e21-30.

Alberta Provincial Genitourinary Tumour Team. Bladder cancer. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2011 Jan. 16 p. (Clinical practice guideline; no. GU-002). [66 references]

R. Madeb, D. Golijanin, K. Noyes, et al.. Treatment of nonmuscle invading bladder cancer: do physicians in the US practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors. Cancer 115 (2009) (2660 – 2670)

Ralph Madeb et al, Treatment of nonmuscle invading bladder cancer: Do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors
Cancer Volume 115, Issue 12, pages 2660–2670, 15 June 2009

Boccardo F, Cannata D, Rubagotti A, et al.: Prophylaxis of superficial bladder cancer with mitomycin or interferon alfa-2b: results of a multicentric Italian study. Journal of Clinical Oncology 12(1): 7-13, 1994.

For Lay version see here

Metastatic bladder cancer – pro

M Levin, MD — Mon, 03 Sep 2012 02:36:41 +0000

Lay Summary: Chemotherapy agents that have shown activity in metastatic bladder cancer include paclitaxel, docetaxel, ifosfamide, gallium nitrate, and gemcitabine.

A prospective, randomized trial of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) compared with cisplatin, cyclophosphamide, and doxorubicin demonstrated improved response and median survival rates (48 weeks vs. 36 weeks, P = .0003) with the former regimen. Results from a randomized trial that compared M-VAC with single-agent cisplatin in advanced bladder cancer also showed a significant advantage with M-VAC in both response rate and median survival (12.5 months vs. 8.2 months, P = .0002). The (outpatient) regimen of paclitaxel and carboplatin achieved response rates in the range of 50% in single-institution phase II trials. [Level of evidence: 3iiiDiii] However, when this regimen was evaluated in a multicenter phase II study conducted by the Southwest Oncology Group, the response rate was only 21%. Gemcitabine has shown activity in phase II trials of patients with metastatic bladder cancer. In a multicenter, randomized, phase III trial comparing the combination of gemcitabine/cisplatin (GC) with the M-VAC regimen in 405 patients with advanced or metastatic bladder cancer, GC yielded similar response rates, time-to-progression, and overall survival (hazard ratio [HR] = 1.04; 95% confidence interval [CI], 0.82-1.32; P = .75) compared with M-VAC, but GC had a better safety profile and was better tolerated than M-VAC. Although this study was not designed to show the equivalence of the 2 regimens, the similar efficacy and reduced toxic effects of GC make it a reasonable alternative in patients who may not tolerate the M-VAC regimen. Another regimen that compares in effectiveness is cispatin/methotrexate/vinblastine.

The regimen of cisplatin/gemcitabine/paclitaxel is in an active phase II trial. As such it is considered by the plan to be investigtional/experimental. It is not standard of care.

Oosterlinck W, Lobel B, Jakse G, Malmstrom PU, Stockle M, Sternberg C Guidelines on bladder cancer.Eur Urol. 2002 Feb;41(2):105-12.

Genitourinary Disease Site Group. Use of chemotherapy in advanced unresectable or metastatic transitional cell carcinoma of the bladder or urothelium [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2002 Jun 19. 20 p. (Practice guideline; no. 3-12). [19 references]

http://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf#search=%22bladder%20cancer%2C%20chemotherapy%20guidelines%22

http://www.uroweb.org/fileadmin/user_upload/Guidelines/2001_Bladder%20_Cancer.PDFGE. Perabo and S. Muller
New agents for treatment of advanced transitional cell carcinoma
Ann. Onc., May 1, 2007; 18(5): 835 – 843.

Cora N. Sternberga, S. Machele Donatb, Joaquim Bellmuntc, Randall E. Millikand, Walter Stadlere, Pieter De Mulderf, Amir Sherifg, Hans von der Maaseh, Taiji Tsukamotoi, Mark S. Solowayj
Chemotherapy for Bladder Cancer: Treatment Guidelines for Neoadjuvant Chemotherapy, Bladder Preservation, Adjuvant Chemotherapy, and Metastatic Cancer Urology Volume 69, Issue 1, Pages 62-79 (January 2007)

Gecitabine/docetaxel for bladder cancer – pro

M Levin, MD — Mon, 03 Sep 2012 02:35:08 +0000

Although advanced urothelial carcinoma is a common and relatively chemosensitive neoplasm, it still remains a fatal disease. Over the last 10 years or so chemotherapy of advanced urothelial tumours has focused on cisplatin-based combinations such as cisplatin-methotrexate-vinblastine (CMV), or methotrexate-vinblastine-adriamycin-cisplatin (M-VAC). Response rates with standard cisplatin-based combination chemotherapy range from 40 to 70%; however, approximately 50% of all patients will develop metastasis, and recent studies indicate that the disease-free long-term (5-year) survival rate is only about 4%. Standard therapy with M-VAC offers a moderate median survival of 1 year; however, it is achieved at the expense of major toxicities, including myelosuppression, nausea, vomiting and nephrotoxicity that often limit its use to patients with normal renal function and adequate performance status. A recent phase III study has indicated that the combination of gemcitabine/cisplatin could replace the standard of care M-VAC since the efficacy was similar in the two regimens with respect to response, time to progressive disease and overall survival; however, toxicity was significantly less in the gemcitabine/cisplatin arm.
There are several pahse II studies of Taxotere/Gemzar with reasonable results. A randomized pahse II study comparing this combination with gemcitabine/cisplatin found a basic equivolence etween the two arms.

D. Pectasides+, J. Glotsos, N. Bountouroglou, A. Kouloubinis, N. Mitakidis, N. Karvounis, N. Ziras and A. Athanassiou Weekly chemotherapy with docetaxel, gemcitabine and cisplatin in advanced transitional cell urothelial cancer: a phase II trial Annals of Oncology 13:243-250, 2002

http://www.lillytrials.com/results_files/gemzar/gemzar_summary_4087.pdf, reported in Proceedings of ASCO 2003;22:390. abs. 1568

A Ardavanis, Gemcitabine and docetaxel as first-line treatment for advanced urothelial carcinoma: a phase II study, British Journal of Cancer (2005) 92, 645-650.

Chemo for bladder cancer – pro

M Levin, MD — Mon, 03 Sep 2012 02:33:45 +0000

A variety of therapeutic options are available to vital, elderly patients with invasive bladder cancer, including radical cystectomy and treatments that preserve the bladder. Radical cystectomy remains the gold standard for treatment of muscle-invasive bladder cancer, but has traditionally been avoided in elderly patients because this population was thought to be at higher risk of morbidity and mortality. A growing body of evidence, however, indicates that the procedure is safe in elderly patients, and is even feasible in those at high risk. However, there still remain situations when cystectomy is not possible. In such cases curative chemo radiation it is reasonable. A neoadjuvant approach is generally supported by guidelines such as NCCN.

A meta-analysis, published in the June 6, 2003 issue of the Lancet, showed that neoadjuvant cisplatin-based chemotherapy improves 5-year survival by approximately 5% in patients with advanced bladder cancer when compared to surgery, radiation therapy, or the combination of radiation therapy and surgery. Recent studies have suggested that the combination of Gemzar® and Platinol® represents the optimal current combination for treatment of advanced or metastatic bladder cancer. Studies have also suggested that the concurrent use of radiation and chemotherapy is superior to sequential use. In many of the current studies, an attempt is made to retain the bladder in those patients who respond to neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy.Some studies use carboplatin, which has largely replaced cisplatin in various cancer types as a less toxic equivalent. This substitution is supported by many studies and by accumulated clinical experience and by NCCN.

There is not much known about second line single agent or combination chemotherapy for urothelial cancer. In the absence of conclusive data, a recent review by Yaffi says that no definitive recommendations can be put forth with regard to second-line systemic therapy. However, some evidence supports the use of cisplatin-based second-line therapy in patients who previously responded to first-line cisplatin-based therapy (more than a 6-month duration from last treatment to progression) and who are considered platinum-sensitive.

NCCN says: “No standard therapy exists in this setting, thus participation in clinical trials of new agents is recommended.
Depending on first-line treatment received, single-agent taxane or gemcitabine is preferred for palliation in this setting.
Additional palliative options include single-agent cisplatin, carboplatin, doxorubicin, 5-FU, ifosfamide, pemetrexed, methotrexate, and vinblastine”.

Chauvet B, Lagrange JL, Geoffrois L, et al. Quality-of-Life (QOL) Assessment After Concurrent Chemoradiation for Invasive Bladder Cancer. Preliminary Results of a French Multicenter Prospective Study. Proceedings of the 45th Annual Meeting of the American Society For Therapeutic Radiology and Oncology. International Journal of Radiation Oncology Biology Physics 2003;57, Number 2, Supplement, Abstract Number 88:S177.

Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant Chemotherapy in Invasive Bladder Cancer:Review and Meta-analysis. Lancet 2003;361:1927-34
Chemoradiation in bladder cancer Bull Cancer. 2005 Dec 1;92(12): 1073-7.

NCCN.ORG, Bladder cancer BL-G, 2018

F.A. Yafi, MD, S. North, MD, and W. Kassouf, MD. First- and second-line therapy for metastatic urothelial carcinoma of the bladder. Curr Oncol. Feb 2011; 18(1): e25e34.

Gemcitabine carboplatin for bladder cancer – pro

M Levin, MD — Tue, 28 Aug 2012 20:10:40 +0000

The standard treatment for advanced bladder cancer is the chemotherapy combination consisting of cisplatin (Platinol®), methotrexate, Velban® (vinblastine) and doxorubicin (Adriamycin®), referred to as M-VAC. However, M-VAC is associated with side effects and are particularly difficult to tolerate for patients who have impaired renal function and/or are elderly. Researchers have been evaluating different chemotherapy combinations for the treatment of advanced bladder cancer in patients who are not able to tolerate M-VAC. A randomized study showed that gemcitabine/cisplatin is as effective and much less toxic. In an attempt to farther reduce toxicity, carboplatin has been substituted for cisplatin. That the two drugs are very similar and carboplatin has been able to substitute for cisplatin in many tumor types. Many such phase II trials have been performed. Two small randomized trials comparing cisplatin-based regimens to carboplatin-based regimens have been published.[13,14] One trial reported a lower complete response rate, while the other trial reported shorter disease-specific survival with the carboplatin-based regimen. However, these studies were underpowered, and the one that showed a disease-specific survival difference included an anthracycline in the cisplatin arm but not in the carboplatin arm. A phase III trial (DeSantis et al) showed that for patients who are older and have Performance Status of 21 or higher, the cisplatin containing regimen was inferior, probably because iof cisplatin toxicity. On the other hand, respones rates were low in both arms, suggesting that overall any chemotherapy was not beneficial. NCCN says that cisplatin should be used for patients with normal renal function and PS >
<2. It implies that carboplatin may be acceptable but recommends split dose cisplatin, while stating that efficacy of such dose modification is not known

Nogué-Aliguer M, Carles J, Arrivi A, et al. Gemcitabine and carboplatin in advanced transitional cell carcinoma of the urinary tract.An alternative therapy. Cancer 2003;97:2180-2186.

Bamias A, Moulopoulos LA, Koutras A, Aravantinos G, Fountzilas G, Pectasides D, Kastritis E, Gika D, Skarlos D, Linardou H, Kalofonos HP, Dimopoulos MA.The combination of gemcitabine and carboplatin as first-line treatment in patients with advanced urothelial carcinoma. A Phase II study of the Hellenic Cooperative Oncology Group.
Cancer. 2006 Jan 15;106(2):297-303.

Petrioli R, Frediani B, Manganelli A, Barbanti G, De Capua B, De Lauretis A, Salvestrini F, Mondillo S, Francini G.Comparison between a cisplatin-containing regimen and a carboplatin-containing regimen for recurrent or metastatic bladder cancer patients. A randomized phase II Cancer. 1996 Jan 15;77(2):344-51.

Maria De Santis, Joaquim Bellmunt, Graham Mead, J. Martijn Kerst, Michael Leahy, Pablo Maroto, Iwona Skoneczna, Sandrine Marreaud, Ronald de Wit and Richard Sylvester Randomized Phase II/III Trial Assessing Gemcitabine/ Carboplatin and Methotrexate/Carboplatin/Vinblastine in Patients With Advanced Urothelial Cancer “Unfit” for Cisplatin-Based Chemotherapy: Phase II—Results of EORTC Study 30986 JCO November 20, 2009 vol. 27

Vaughn DJ: Chemotherapeutic options for cisplatin-ineligible patients with advanced carcinoma of the urothelium. Cancer Treat Rev 34 (4): 328-38, 2008.

NCCN BCL-6, 2014

MVAC for bladder cancer – pro

M Levin, MD — Tue, 28 Aug 2012 20:09:04 +0000

Systemic chemotherapy is the only modality that has been shown in phase 3 trials to improve survival in responding patients with advanced bladder cancer).The M-VAC regimen, first reported in 1985 by investigators from Memorial Sloan-Kettering Cancer Center, revealed that urothelial carcinoma was sensitive to chemotherapy. Patients with measurable lesions were found to have a remarkably high response rate of 72%, and 36% attained complete response. Long-term survival was achieved in patients who attained complete response. In addition, patients who achieved a complete response with the combination of chemotherapy and surgery had twice the survival of patients who had only a partial response to chemotherapy and no further surgery (level 3). The median overall survival time for the whole group was 13.1 months. Chemotherapy was more effective in patients with nodal disease only compared with patients who had visceral metastases.

In an update of these results, a retrospective analysis of 5 different M-VAC trials encompassing 203 patients from Memorial Sloan-Kettering Cancer Center was reported. Among 194 evaluable patients, 46 patients achieved a complete response (24%) and 84 patients a partial response (43%), yielding an overall response rate of 67%. The median survival time for all 203 patients was 14.8 months, with a 5-year survival rate of 17% (level 3). The 5-year survival rate for the 46 patients with a complete response after chemotherapy alone was 40%. An additional 30 patients achieved complete response after chemotherapy followed by surgery, with a 5-year survival rate of 33%.Similar results apply in the treatment of metastatic disease.

In the Memorial Sloan-Kettering Cancer Center experience, M-VAC has been associated with severe toxicity and long-term survival in only 15% of patients with visceral metastases and in 30% of patients with nodal disease. The need for improved efficacy and reduced toxicity has led investigators to continue to seek less toxic and more effective regimens. A number of such regimens have been tried. Although CM, CMV, and M-VAC have never been compared in randomized studies, most centers have considered M-VAC to be the standard regimen.

Von der Maase H, Hansen SW, Roberts JT, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 2000;18:3068-3077

NCCN.ORG, Bladder cancer

C. Sternberg, S. Donat, J. Bellmunt, R. Millikan, W. Stadler, P. De Mulder, A. Sherif, H. von der Maase, T. Tsukamoto, M. Soloway, Chemotherapy for Bladder Cancer: Treatment Guidelines for Neoadjuvant Chemotherapy, Bladder Preservation, Adjuvant Chemotherapy, and Metastatic Cancer.
Urology, Volume 69, Issue 1, Pages 62-79, 2007

PET for bladder cancer – pro

M Levin, MD — Thu, 23 Aug 2012 17:52:43 +0000

Conventional PET using FDG is unsuitable for imaging bladder tumors because of its high urinary excretion. However, it is 67% sensitive, 86% specific and 80% accurate in detecting pathologic lymph nodes in patients with bladder cancer, which exceeds both CT and MRI. Although PET scans are being used as part of research projects in bladder cancer, it is not yet certain how valuable they are in helping to manage the care of patients with bladder cancer. According to a recent review article. “PET demonstrates limited utility in diagnosis and staging of bladder cancer”. A recent guideline says: “PET studies to date are not proven to enhance pretreatment staging and are not indicated until further validation and studies are completed.”
However, a more recent guideline says: “Therefore, “fluorine-18 fluorodeoxyglucose (FDG-PET) might be useful in detecting perivesical tumor growth or distant metastasis in patients with advanced bladder cancer, and for the early detection of recurrent cancer following therapy, although a major remaining pitfall is the intense FDG accumulation due to excretion in the urine…. A study correlating 18F-FDG-PET and CT results in the same patients reported sensitivity, specificity, and accuracy of 60%, 88%, and 78%, respectively, in nodal and metastasis staging, suggesting improved distant metastatic and locoregional node staging. ”

The 2009 ACR guideline rates PET as 2/10, which is “not recommended”. NCCN does not recommend PET.

Jafri SZ, Shetty M, Choyke PL, Bluth EI, Bush WH Jr, Casalino DD, Francis IR, Kawashima A, Papanicolaou N, Rosenfield AT, Sandler CM, Segal AJ, Tempany C, Resnick MI, Expert Panel on Urologic Imaging. Pretreatment staging of invasive bladder cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 8 p. [51 references]

http://www.moffitt.org/moffittapps/ccj/v9n4/pdf/335

Jafri SZ, Dinan D, Francis IR, Baumgarten DA, Bluth EI, Bush WH Jr., Casalino DD, Curry NS, Israel GM, Kawashima A, Papanicolaou N, Remer Leyendecker JR, Francis IR, Casalino DD, Arellano RS, Baumgarten DA, Curry NS, Dighe M, Israel GM, Papanicolaou N, Prasad S, Ramchandani P, Remer EM, Sheth S, Fulgham P, Expert Panel on Urologic Imaging. ACR Appropriateness Criteria® pretreatment staging of invasive bladder cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2009. 9 p. [82 references

Jafri SZ, Dinan D, Francis IR, Baumgarten DA, Bluth EI, Bush WH JR, Casalino DD, Curry NS, Israel GM, Kawashima A, Papanicolaou N, Remer EM, Sandler CM, Spring DB, Fulgham P, Expert Panel on Urologic Imaging. Follow-up imaging of bladder carcinoma. [online publication]. Reston (VA): American College of Radiology (ACR); 2007. 9 p. [71 references]

nccn bladder 2018

Taxotere and gemcitabine for bladder cancer – pro

M Levin, MD — Thu, 23 Aug 2012 17:47:22 +0000

A variety of therapeutic options are available to patients with metastatic bladder cancer. More recently, gemcitabine and cisplatin was found to be as effective and less toxic than MIAD, but the cisplatin still produces much toxicity. Gemcitabin and docetaxel has been studied in an attempt to minimize toxicity; it showed response rates of 40%–60%. In a phase ii trial of the same regimen in a weekly schedule, a cr of 42% (mds: 11.9 months) was achieved, but the excitement with these results was damped by the high level of associated pulmonary toxicity (including 1 death) . Furthermore, a regimen consisting of docetaxel and gemcitabine showed promising response rates of 30%–50% and median OS times of 13–15 months in phase ii trials. It is an acceptable regimen per NCCN. It recommends the following for first line therapy:

Gemcitabine and cisplatin,(category 1)

DDMVAC with growth factor support (category 1)

•

Alternative regimens

Carboplatin- or taxane-based regimens, or single-agent chemotherapy (category 2B). This recommendation support docetaxel and gemcitabine.

NCCN.ORG, Bladder cancer BG,2, 2014

Manola JB, Dreicer R, Wilding G. Gemcitabine and docetaxel in advanced carcinoma of the urothelium: report of a phase II Eastern Cooperative Oncology Group trial. Program and abstracts of the American Society of Clinical Oncology 38th Annual Meeting, May 18-21, 2002; Orlando, Florida. Abstract 796

F.A. Yafi, MD, S. North, MD, and W. Kassouf, MD. First- and second-line therapy for metastatic urothelial carcinoma of the bladder

Dreicer R, Manola J, Schneider DJ, Schwerkoske JF, George CS, Roth BJ, Wilding G; Eastern Cooperative Oncology Group. Phase II trial of gemcitabine and docetaxel in patients with advanced carcinoma of the urothelium: a trial of the Eastern Cooperative Oncology Group.Cancer. 2003 Jun 1;97(11):2743-7. Galsky, Matthew D. The Role of Taxanes in the Management of Bladder Cancer Oncologist 2005 10: 792-798
Galsky, Matthew D.
The Role of Taxanes in the Management of Bladder Cancer
Oncologist 2005 10: 792-798

Less is known about how to deal with recurrent metastatic disease. NCCN says: “No standard therapy exists in this setting. Options include single agent therapy with a taxane or premetrexed…”.In one trial, docetaxel and gemcitabine combination therapy in patients with progressing regional or metastatic transitional cell carcinoma who had failed a prior chemotherapy treatment. Five patients obtained an objective response for an overall response rate of 17% (90% confidence interval, 7-33%). One patient achieved a complete clinical response. The median overall survival of the group was 7.7 months .The authors concluded that for patients who have failed a previous chemotherapy regimen, this gemcitabine-docetaxel combination may be a useful alternative; however, it was obviously not a very active regimen.

NCCN.ORG, Bladder Cancer, BG-2, 2014