In patients with locally advanced bladder cancer (LABC), the use of adjuvant chemotherapy plus sequential radiotherapy (RT) is associated with significant improvements in locoregional recurrence-free survival (LRFS) and modest improvements in disease-free survival compared with chemotherapy alone, according to a recent study.
Even with chemotherapy, locoregional failure is common following radical cystectomy (RC) in patients with LABC and is associated with high rates of morbidity and mortality.
To compare the effectiveness of chemotherapy plus RT (n = 75) vs adjuvant chemotherapy alone (n = 45) for the treatment of LABC, researchers conducted a phase II trial of patients aged 70 years or younger with bladder cancer. All patients included in the study had one or more risk factors (pT3b or higher, grade 3, or positive nodes) with negative margins after radical cystectomy plus pelvic lymph node dissection, as well as an Eastern Cooperative Oncology Group performance status of 0 to 2, no evidence of distant metastases on CT scan of the abdomen and pelvis or on chest imaging, and sufficient renal, hepatic, and hematologic function. Enrollment for the study took place from December 2002 to July 2008, and data were assessed from August 3, 2015, to January 6, 2016.
Results of the study were published in JAMA Surgery (online November 29, 2017; doi:10.1001/jamasurg.2017.4591).
Ultimately, results from both treatment arms had favored chemotherapy plus RT vs chemotherapy alone. The 2-year outcomes and overall adjusted hazard ratios for chemotherapy plus RT vs chemotherapy alone had been 96% vs 69% for LRFS, 68% vs 56% for disease-free survival, and 71% vs 60% for overall survival.
The researchers noted that five patients (7%) in the chemotherapy plus RT arm had experienced R-associated late grade 3 gastrointestinal tract adverse effects.
“Adjuvant chemotherapy plus RT was reasonably well tolerated and was associated with significant improvements in LRFS and marginal improvements in disease-free survival vs chemotherapy alone in LABC,” the researchers concluded. “The addition of adjuvant RT should be considered for LABC. This regimen warrants further study in phase III trials.”—Christina Vogt