Bladder preservation with induction chemotherapy (carboplatin/paclitaxel) followed by radiotherapy with concurrent paclitaxel. A study of the Hellenic Cooperative Oncology Group
Reviewer: Ryan Smith, MD
Ultima Vez Modificado: 1 de junio del 2003
Presenter: G. Aravantinos
Presenter's Affiliation: Hellenic Cooperative Oncology Group
Type of Session: Poster
- Radical cystectomy remains the standard of care treatment for invasive bladder cancer.
- Comparable results have been obtained with combined chemotherapy and radiation therapy with bladder preservation
- Previous studies have been published using cisplatin/paclitaxel or cisplatin/gemcitabine regimens with a fair amount of acute and late toxicity
- This study investigates the use of carboplatin and paclitaxel in bladder sparing regimens in the treatment of bladder cancer
Materials and Methods
- 42 patients were enrolled in the study
- All patients were not amenable to resection or refused resection
- Induction chemotherapy was done for 3 cycles, consisting of carboplatin with an AUC of 5 and paclitaxel of 175 mg/m2
- After reevaluation, patients began chemoradiation, treated with 33 fractions of 1.8 Gy to a dose of 59.4 Gy with weekly paclitaxel (50 mg/m2)
- Primary endpoints were time to progression (TTP) and survival
- Induction chemotherapy was well-tolerated, with <15% with leukopenia, and a high incidence of neutropenia with no consequence. Grade 3 peripheral neuropathy was only 4%
- Concurrent chemoradiation was also well-tolerated
- 23 patients were available for assessment for response to chemotherapy, with 12 patients (52%) demonstrating a complete response and an additional 3 patients demonstrating a partial response
- 15 patients were evaluable for chemoradiation, and 9 patients had a complete response (48%)
- Median time to progression was 8.3 months
- Median survival was 14.8 months
- Induction chemotherapy with chemoradiation with carboplatin/paclitaxel in patients with invasive bladder cancer appears to be well-tolerated with promising preliminary results of efficacy
The results are promising, but preliminary, as many of the patients even enrolled were not available for evaluation. The data was not updated from that submitted. There are additional questions of the study, which are mainly how the responses were analyzed (biopsies?, cystoscopy only?, radiologic imaging?) and whether the response rates presented for chemoradiation were in addition to those presented for chemotherapy alone. If so, these complete response rates would be very impressive. The results presented are for a small number of patients, which seem to be poorer prognosis patients, as they were usually unresectable. However, as the traditional chemotherapy (cisplatin based) can be quite toxic (both acute and long term-with decrease in bladder capacity and dysuria being most concerning), this is an important investigation into better tolerated chemotherapy regimens. More data should be collected on the use of carboplatin and paclitaxel to determine its ultimate efficacy in the seting of bladder preserving treatment for bladder cancer.
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