In 2016 about 80,000 people were diagnosed with bladder cancer, which is the ninth leading cause of death in the United States.1 Although progress in treating the disease improved tremendously over the last 30 years, more recently, the development of new and effective treatments has stalled.

“It has been about 17 years since there has been an FDA [U.S. Food and Drug Administration] approval of a drug to treat non-muscle-invasive bladder cancer,” James M. McKiernan, MD, the John K. Lattimer professor of urology and chair of the department of urology at Columbia University in New York, New York, told Cancer Therapy Advisor. “We cannot keep going like this.”

At an education session at the 2017 Genitourinary Cancers Symposium Dr McKiernan and other experts will discuss some of the barriers to progress in the treatment of both muscle-invasive and non-muscle-invasive bladder cancer.

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Optimizing Neoadjuvant Chemotherapy

About 1 in 3 patients with bladder cancer present with muscle-invasive disease, and about one-half of these patients will develop distant metastasis.2 Because of this, there is great interest in establishing standards of care to treat these patients based on the best available evidence.

During the education session, Maria De Santis, MD, associate clinical professor at the University of Warwick’s Cancer Research Centre in Coventry, England, will discuss the role of neoadjuvant chemotherapy among patients with muscle-invasive disease.

“Neoadjuvant chemotherapy is currently the standard of care for treatment of muscle-invasive bladder cancer according to guidelines issued by both the European Association of Urology and the American Society of Clinical Oncology,” Dr De Santis told Cancer Therapy Advisor.

Use of cisplatin-based neoadjuvant therapy is shown to increase overall survival of these patients, but there are few data on which regimens work best, and use of these therapies requires careful patient selection.4 A significant number of patients are not eligible for cisplatin-based chemotherapy because of the known side effect profile; among the major concerns are a long-term reduction in renal function, which runs a higher risk with older age and in patients with continent urinary diversion.

“We can reduce the potential negative effect of cisplatin on renal function with the use of split dose cisplatin, though this has not been used in the pivotal trials,” Dr De Santis said. “One of the other concerns about neoadjuvant chemotherapy is an increase in perioperative morbidity, but this was neither documented in the prospective trials nor in more recent retrospective analyses.”

Dr De Santis said there are still several unmet needs for the treatment of patients with metastatic or muscle-invasive disease. More research is needed to allow for better selection of patients for cisplatin-based chemotherapy. The field needs less toxic and more effective treatments and combinations for the perioperative setting that will allow more patients to benefit from neoadjuvant systemic treatment.