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Adjuvant Chemotherapy Improves Survival in Patients With Locally Advanced Bladder Cancer

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Key Points

  • A comparative effectiveness study found that patients receiving adjuvant chemotherapy after surgical treatment had improved overall survival vs those who received surgical treatment alone.
  • The analysis supports the use of chemotherapy after surgery for patients with locally advanced bladder cancer.

Patients who received chemotherapy after bladder cancer surgery demonstrated an approximately 30% lower risk of death than those who underwent surgery alone, according to an analysis presented by researchers at the Icahn School of Medicine at Mount Sinai at the 2015 Genitourinary Cancers Symposium, held February 26 to 28 in Orlando (Abstract 292).

Clinical trials have established the benefit of giving chemotherapy prior to surgery for patients with bladder cancer. However, clinical trials exploring giving adjuvant chemotherapy have been difficult to interpret, and many of the trials closed early due to poor accrual without providing an answer.

Study Details

In this large comparative effectiveness study, lead researcher Matthew Galsky, MD, and colleagues used the National Cancer Database to identify patients who underwent cystectomy for ≥ pT3 and/or pN+ M0 bladder cancer. Specifically, the study found that patients receiving adjuvant chemotherapy after surgical treatment had improved overall survival when compared with patients who received surgical treatment alone with only postsurgical observation (hazard ratio = 0.69, 95% confidence interval = 0.60–0.78).

“Until now, data supporting adjuvant chemotherapy have been mixed,” said Dr. Galsky, Associate Professor of Medicine, Hematology, and Medical Oncology and Assistant Professor of Urology at the Icahn School of Medicine at Mount Sinai. “Our analysis of actual cases supports the use of chemotherapy after surgery for patients with locally advanced bladder cancer.”

Of the 5,653 patients analyzed, 1,293 patients received adjuvant chemotherapy plus cystectomy vs 4,360 patients who received cystectomy alone.

“Chemotherapy prior to surgery remains the optimal approach for patients with bladder cancer based on the available evidence. However, population-based observational studies may be used to help fill the knowledge void in situations where clinical trials have not yielded definitive evidence. This comparative effectiveness analysis may help inform the care of patients with bladder cancer who have not received chemotherapy prior to surgery,” Dr. Galsky said.

This study was a collaborative effort by researchers at the Tisch Cancer Institute at Mount Sinai, Departments of Preventative Medicine and Urology at the Icahn School of Medicine at Mount Sinai, and the Lahey Clinic in Burlington, Massachusetts.

For full disclosures of the study authors, view the study abstract at abstract.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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