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8 - The chemotherapeutic management of bladder cancer

Published online by Cambridge University Press:  25 August 2009

By
Delia Pudney ,
Joanne Stokoe  and
Robert Huddart
Edited by
David MacVicar
David MacVicar
Affiliation:
Royal Marsden Hospital
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Summary

sIntroduction

Approximately 20% of patients diagnosed with bladder cancer have muscle invasion at the time of presentation, and up to 50% of these patients will develop metastatic disease after successful local treatment. Bladder cancer is a relatively chemosensitive disease, with objective response rates of up to 25% with single agent chemotherapy and response rates of up to 50% with combination chemotherapy. The most commonly used regimens have historically been those combining cisplatin, methotrexate, vinca alkaloids and doxorubicin. In more recent years, the development of newer agents has led trials examining the role of gemcitabine and docetaxel as first- and second-line treatment for advanced bladder cancer. Care must be taken in delivering chemotherapy to patients with significant renal impairment as cisplatin is renally toxic, and methotrexate is excreted via the kidneys. In patients with renal insufficiency, carboplatin can be substituted for cisplatin and plasma methotrexate levels should be monitored and folinic acid rescue employed to prevent life-threatening toxicity.

Chemotherapy for bladder cancer is used in the neoadjuvant and adjuvant setting in combination with radical local treatment (cystectomy or radiotherapy) or for palliation in patients with advanced disease. Concurrent chemotherapy with radiotherapy has also been given with the aim of improving the therapeutic ratio of radical radiotherapy.Table 8.1 describes the scheduling of the chemotherapy regimens commonly used for the management of bladder cancer.

Neoadjuvant chemotherapy

Neoadjuvant chemotherapy has two potential therapeutic benefits: to improve the likelihood of bladder preservation and to eradicate micrometastatic disease.

Type
Chapter
Information
Carcinoma of the Bladder , pp. 125 - 136
Publisher: Cambridge University Press
Print publication year: 2008

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References

,Advanced Bladder Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 2003; 361: 1927–34.CrossRefGoogle Scholar
Grossman, H B, Natale, R B, Tangen, C Met al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003; 349: 859–66.CrossRefGoogle ScholarPubMed
,International Collaboration of Trialists. Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: a randomised controlled trial. Lancet 1999; 354: 533–40.CrossRefGoogle Scholar
Hall, R.On behalf of the International Collaboration of Trialists of the MRC Bladder Cancer Group; MRC Clinical Trials Unit, UK: Updated results of a randomised controlled trial of neoadjuvant cisplatin (C) methotrexate (M) and vinblastine (V) for muscle-invasive bladder cancer. In: Proceedings of the American Society of Clinical Oncology, Thirty-Eighth Annual Meeting, 2002; Orlando, Florida.Google Scholar
Sherif, A, Holmberg, L, Rintala, Eet al. Neoadjuvant cisplatinum based combination chemotherapy in patients with invasive bladder cancer: a combined analysis of two Nordic studies. Eur Urol 2004; 45: 297–303.CrossRefGoogle ScholarPubMed
,Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 2005; 48: 202–5; discussion 205–6.CrossRefGoogle Scholar
Pearcey, R, Brundage, M, Drouin, Pet al. Phase III trial comparing radical radiotherapy with and without cisplatin chemotherapy in patients with advanced squamous cell cancer of the cervix. J Clin Oncol 2002; 20: 966–72.CrossRefGoogle ScholarPubMed
Pignon, J P, Bourhis, J, Domenge, C, Designe, L.Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet 2000; 355: 949–55.CrossRefGoogle Scholar
Rose, P G, Bundy, B N, Watkins, E Bet al. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999; 340: 1144–53.CrossRefGoogle ScholarPubMed
Coppin, C M, Gospodarowicz, M K, James, Ket al. Improved local control of invasive bladder cancer by concurrent cisplatin and preoperative or definitive radiation. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1996; 14: 2901–7.CrossRefGoogle ScholarPubMed
Gogna, N K, Matthews, J H, Turner, S Let al. Efficacy and tolerability of concurrent weekly low dose cisplatin during radiation treatment of localized muscle invasive bladder transitional cell carcinoma: a report of two sequential Phase II studies from the Trans Tasman Radiation Oncology Group. Radiother Oncol 2006; 81: 9–17.CrossRefGoogle Scholar
Hussain, S A, Stocken, D D, Riley, Pet al. A phase I/II study of gemcitabine and fractionated cisplatin in an outpatient setting using a 21-day schedule in patients with advanced and metastatic bladder cancer. Br J Cancer 2004; 91: 844–9.CrossRefGoogle Scholar
,Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Eur Urol 2005; 48: 189–99; discussion 199–201.CrossRefGoogle Scholar
Bajorin, D F, Dodd, P M, Mazumdar, Met al. Long-term survival in metastatic transitional-cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol 1999; 17: 3173–81.CrossRefGoogle Scholar
Hillcoat, B L, Raghavan, D, Matthews, Jet al. A randomized trial of cisplatin versus cisplatin plus methotrexate in advanced cancer of the urothelial tract. J Clin Oncol 1989; 7: 706–9.CrossRefGoogle ScholarPubMed
Loehrer, P J, Einhorn, L H, Elson, P Jet al. A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 1992; 10: 1066–73.CrossRefGoogle ScholarPubMed
Papamichael, D, Gallagher, C J, Oliver, R Tet al. Phase II study of paclitaxel in pretreated patients with locally advanced/metastatic cancer of the bladder and ureter. Br J Cancer 1997; 75: 606–7.CrossRefGoogle ScholarPubMed
Yang, M H, Yen, C C, Chang, Y Het al. Single agent paclitaxel as a first-line therapy in advanced urothelial carcinoma: its efficacy and safety in patients even with pretreatment renal insufficiency. Jpn J Clin Oncol 2000; 30: 547–52.CrossRefGoogle ScholarPubMed
Harker, W G, Meyers, F J, Freiha, F Set al. Cisplatin, methotrexate, and vinblastine (CMV): an effective chemotherapy regimen for metastatic transitional cell carcinoma of the urinary tract. A Northern California Oncology Group study. J Clin Oncol 1985; 3: 1463–70.CrossRefGoogle ScholarPubMed
Sternberg, C N, Yagoda, A, Scher, H I.Chemotherapy for advanced urothelial tract tumors: the M-VAC regimen. Prog Clin Biol Res 1988; 277: 45–51.Google ScholarPubMed
Sternberg, C N, Yagoda, A, Scher, H Iet al. Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. Cancer 1989; 64: 2448–58.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
Loehrer, P J, Elson, P, Dreicer, Ret al. Escalated dosages of methotrexate, vinblastine, doxorubicin, and cisplatin plus recombinant human granulocyte colony-stimulating factor in advanced urothelial carcinoma: an Eastern Cooperative Oncology Group trial. J Clin Oncol 1994; 12: 483–8.CrossRefGoogle ScholarPubMed
Sternberg, C N, Mulder, P H, Oosterom, A Tet al. Escalated M-VAC chemotherapy and recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) in patients with advanced urothelial tract tumors. Ann Oncol 1993; 4: 403–7.CrossRefGoogle ScholarPubMed
Sternberg, C N, Mulder, P, Schornagel, J Het al. Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours. Eur J Cancer 2006; 42: 50–4.CrossRefGoogle ScholarPubMed
Sternberg, C N, Mulder, P H, Schornagel, J Het al. Randomized phase III trial of high-dose-intensity methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy and recombinant human granulocyte colony-stimulating factor versus classic MVAC in advanced urothelial tract tumors: European Organization for Research and Treatment of Cancer Protocol no. 30924. J Clin Oncol 2001; 19: 2638–46.CrossRefGoogle ScholarPubMed
Dimopoulos, M A, Bakoyannis, C, Georgoulias, Vet al. Docetaxel and cisplatin combination chemotherapy in advanced carcinoma of the urothelium: a multicenter phase II study of the Hellenic Cooperative Oncology Group. Ann Oncol 1999; 10: 1385–8.CrossRefGoogle ScholarPubMed
Garcia del Muro, X, Marcuello, E, Guma, Jet al. Phase II multicentre study of docetaxel plus cisplatin in patients with advanced urothelial cancer. Br J Cancer 2002; 86: 326–30.CrossRefGoogle ScholarPubMed
Vaughn, D J, Manola, J, Dreicer, Ret al. Phase II study of paclitaxel plus carboplatin in patients with advanced carcinoma of the urothelium and renal dysfunction (E2896): a trial of the Eastern Cooperative Oncology Group. Cancer 2002; 95: 1022–7.CrossRefGoogle ScholarPubMed
Dreicer, R, Manola, J, Roth, B Jet al. Phase III trial of methotrexate, vinblastine, doxorubicin, and cisplatin versus carboplatin and paclitaxel in patients with advanced carcinoma of the urothelium. Cancer 2004; 100: 1639–45.CrossRefGoogle ScholarPubMed
Bamias, A, Aravantinos, G, Deliveliotis, Cet al. Docetaxel and cisplatin with granulocyte colony-stimulating factor (G-CSF) versus MVAC with G-CSF in advanced urothelial carcinoma: a multicenter, randomized, phase III study from the Hellenic Cooperative Oncology Group. J Clin Oncol 2004; 22: 220–8.CrossRefGoogle ScholarPubMed
Uhm, J E, Lim, H Y, Kim, W Set al. Paclitaxel with cisplatin as salvage treatment for patients with previously treated advanced transitional cell carcinoma of the urothelial tract. Neoplasia 2007; 9: 18–22.CrossRefGoogle ScholarPubMed
Lorusso, V, Pollera, C F, Antimi, Met al. A phase II study of gemcitabine in patients with transitional cell carcinoma of the urinary tract previously treated with platinum. Italian Co-operative Group on Bladder Cancer. Eur J Cancer 1998; 34: 1208–12.CrossRefGoogle ScholarPubMed
Moore, M J, Winquist, E W, Murray, Net al. Gemcitabine plus cisplatin, an active regimen in advanced urothelial cancer: a phase II trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1999; 17: 2876–81.CrossRefGoogle ScholarPubMed
der Maase, H, Andersen, L, Crino, Let al. Weekly gemcitabine and cisplatin combination therapy in patients with transitional cell carcinoma of the urothelium: a phase II clinical trial. Ann Oncol 1999; 10: 1461–5.CrossRefGoogle Scholar
der Maase, H, Hansen, S W, Roberts, J Tet 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: 3068–77.CrossRefGoogle Scholar
der Maase, H, Sengelov, L, Roberts, J Tet al. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 2005; 23: 4602–8.CrossRefGoogle Scholar
der Maase, H, Hansen, S W, Liepa, Aet al. Health care resource use for patients with advanced bladder cancer treated with gemcitabine plus cisplatin (GC) versus MVAC in a phase III trial. Ann Oncol 2000; 11(suppl 4): 74 (abst 3270).Google Scholar
Bellmunt, J, Guillem, V, Paz-Ares, Let al. Phase I-II study of paclitaxel, cisplatin, and gemcitabine in advanced transitional-cell carcinoma of the urothelium. Spanish Oncology Genitourinary Group. J Clin Oncol 2000; 18: 3247–55.CrossRefGoogle ScholarPubMed
Bellmunt, J, Ribas, A, Eres, Net al. Carboplatin-based versus cisplatin-based chemotherapy in the treatment of surgically incurable advanced bladder carcinoma. Cancer 1997; 80: 1966–72.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Mead, G M, Russell, M, Clark, Pet al. A randomized trial comparing methotrexate and vinblastine (MV) with cisplatin, methotrexate and vinblastine (CMV) in advanced transitional cell carcinoma: results and a report on prognostic factors in a Medical Research Council study. MRC Advanced Bladder Cancer Working Party. Br J Cancer 1998; 78: 1067–75.CrossRefGoogle Scholar
Cullen, M, Steven, N, Billingham, Let al. Antibacterial prophylaxis after chemotherapy for solid tumors and lymphomas. N Engl J Med 2005; 353: 988–98.CrossRefGoogle ScholarPubMed
Fossa, S D, Sternberg, C, Scher, H Iet al. Survival of patients with advanced urothelial cancer treated with cisplatin-based chemotherapy. Br J Cancer 1996; 74: 1655–9.CrossRefGoogle ScholarPubMed
Cook, A M, Huddart, R A, Jay, Get al. The utility of tumour markers in assessing the response to chemotherapy in advanced bladder cancer. Br J Cancer 2000; 82: 1952–7.Google ScholarPubMed

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