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Two Studies Provide Answers on Best Approach to Bladder Cancer Treatment

Daniel M. Geynisman, MD

 

Two new studies from researchers at Fox Chase Cancer Center provide clinicians with more information on when it might be appropriate for patients with bladder cancer to undergo cystectomy.

In the first, Daniel M. Geynisman, MD, associate professor in the Department of Hematology/Oncology at Fox Chase, and colleagues found that some patients with muscle-invasive urothelial carcinoma may not need to undergo cystectomy.

Presented at the American Society of Clinical Oncology’s 2021 Genitourinary Cancers Symposium, interim analysis results of the RETAIN BLADDER trial showed that 92.3% of patients selected to retain their bladders were alive after undergoing cisplatin-based neoadjuvant chemotherapy, and 88.5% had no disease progression. 

Patients were selected using a risk-adapted approach to treatment that screened their tumors for specific mutations. These patients were then monitored using active surveillance. The primary endpoint of metastasis-free survival will be evaluated at two years. 

“If at the two-year mark for the 71 patients, the survival with no disease is similar to what we would expect if everyone got regular standard of care but a third of the patients are spared a cystectomy, that’s a win,” Geynisman said.

The second study by Matthew R. Zibelman, MD, assistant professor in the Department of Hematology/Oncology at Fox Chase, and colleagues evaluated the use of cystoscopy for predicting the presence of muscle-invasive bladder cancer in patients who are candidates for cystectomy. 

In the study, 61 patients with bladder cancer underwent endoscopic assessment before receiving curative bladder removal surgery. The results of the evaluation were compared with pathology after bladder removal. The study showed that 25% of people who appeared to have completely clean bladders through cystoscopy actually harbored muscle-invasive disease that could be observed when the bladder was removed.

“There were reports over the years stating that you could miss tumors through endoscopic assessment. Yet, the issue was never approached systematically and tackled in a standardized way,” said Alexander Kutikov, MD, FACS, chief of the Division of Urology and Urologic Oncology, who was the primary investigator for the trial. “I anticipated that the retrospective literature was overestimating the risk. But there is a risk, and this helps us design further clinical trials and helps us find research directions to overcome this barrier.”

The authors noted that future efforts should be aimed at developing new imaging and biomarker methods to improve evaluations before the bladder is removed.

The study, “Cystoscopy and Systematic Bladder Tissue Sampling in Predicting pT0 Bladder Cancer: A Prospective Trial,” was published in The Journal of Urology.