Neoadjuvant gemcitabine-based chemotherapy, followed by gemcitabine-based concomitant chemoradiation, may aid in bladder preservation for patients receiving treatment for muscle-invasive bladder cancer in under-resourced countries, according to the results of a study conducted in Pakistan and presented at the 2017 ASCO Annual Meeting (June 2-6; Chicago, IL).
Urinary bladder cancer is commonly seen in Pakistan, and is often diagnosed at later stages due to factors such as illiteracy and lack of access to medical care, according to Abdul Mateen, MD, clinical oncologist at MINAR Cancer Hospital (Multan, Pakistan).
“Urinary bladder cancer is especially common in the population of people who consume smokeless tobacco,” Dr Mateen wrote.
Treatment options for muscle-invasive bladder cancer are limited in poor resource countries. Dr Mateen and colleagues enrolled 65 patients in a study of neoadjuvant chemotherapy, followed by adjuvant chemoradiation. Patients received a course of gemcitabine and cisplatinum every 3 weeks (1000 mg/m2 on day 1 and 40 mg/m2 on day 8 of each cycle), after which bladder mass was evaluated using ultrasonography.
Patients without evidence of disease progressed to whole-bladder external radiation (63 Gy total, given in five weekly fractions of 1.8 Gy), concomitantly administered with weekly gemcitabine (100 mg/m2). Disease-free survival (DFS) served as the primary outcome measure, with overall survival (OS) as a secondary outcome measure.
Eleven patients were excluded from the final analysis due to treatment cessation, and five patients were switched to alternative treatments following signs of recurrence. Commonly observed low-grade adverse events included bladder dysfunction (n = 15), bowel dysfunction (n = 11), and hematologic toxicity (n = 8).
The cohort had a 4-year DFS rate of 43%, along with an OS rate of 51%. The mean and median DFS was 3.16±0.36 years (95% CI, 2.91-3.42), and the mean and median OS was 3.55±0.31 years (95% CI, 3.37-3.76).
“Neoadjuvant chemotherapy with GC followed by concomitant CRT using gemcitabine is an excellent choice for bladder preservation in poor resource countries,” authors of the study concluded.—Cameron Kelsall
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