Advertisement

Neoadjuvant Versus Adjuvant Chemotherapy in Invasive Bladder Cancer

  • H. I. Scher
Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 126)

Abstract

Invasive bladder tumors represents a range of diseases that vary clinically from minimally invasive with a low metastatic potential, to high grade lesions that metastasize early despite minimal invasion, to large fixed lesions that present with urinary obstruction and pain [1,2]. As the prognosis for each of these groups varies, so should the therapy. Too often, however, a uniform treatment approach is used for all of these clinical scenarios. This approach is becoming outmoded; while the treatment options for invasive bladder tumors are myriad, it is now apparent that chemotherapy is playing an increasingly important role in the management of these malignancies [3]. This is based on the high rate of systemic failure—the major cause of mortality following local treatment modalities—the high response proportion to modern combination regimens, and the possibility that chemotherapy may allow organ preservation. Critical to improving treatment selection for an individual patient is the refinement of our ability to define the biologic behavior of these tumors, both with respect to metastatic risk and sensitivity to treatment. Only then can a specific approach be advised that offers the highest probability of cure with the least morbidity.

Keywords

Bladder Cancer Radical Cystectomy Invasive Bladder Cancer Response Proportion Partial Cystectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Whitmore WF (1983) Management of invasive bladder neoplasms. Semin Urol 1:4–10Google Scholar
  2. 2.
    Droller MJ (1986) Bladder cancer. In: Graham SD (ed) Urologic oncology. New York, Raven, New York, pp 293–321Google Scholar
  3. 3.
    Scher HI (1990) Chemotherapy for invasive bladder cancer: neo-adjuvant vs. adjuvant. Semin Oncol 17:555–565PubMedGoogle Scholar
  4. 4.
    Montie JE, Straffon RA, Stewart BH (1984) Radical cystectomy without radiation therapy for carcinoma of the bladder. J Urol 131:477–482PubMedGoogle Scholar
  5. 5.
    Pagano F, Bassi P, Galetti TP et al. (1991) Results of contemporary radical cystectomy for invasive bladder cancer: a clinicopathological study with an emphasis on the inadequacy of the tumor, nodes and metastases classification. J Urol 145:45–50PubMedGoogle Scholar
  6. 6.
    Skinner DG, Lieskovsky G (1984) Contemporary cystectomy with pelvic node dissection compared to preoperative radiation therapy plus cystectomy in the management of invasive bladder cancer. J Urol 131:1069–1072PubMedGoogle Scholar
  7. 7.
    Feinstein AR, Sossin DM, Wells CR (1985) The Will Rogers phenomenon: stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Eng J Med 312:1604–1608CrossRefGoogle Scholar
  8. 8.
    Tannock I (1990) The current status of adjuvant chemotherapy for bladder cancer. Semin Urol 8:291–297PubMedGoogle Scholar
  9. 9.
    Warner JA, Whitmore WF, Fair WR (1992) Prognosis following cystectomy for node positive bladder cancer. J Urol (submitted)Google Scholar
  10. 10.
    Sternberg C, Yagoda A, Scher H et al. (1985) Preliminary results of methotrexate, vinblastine, adriamycin and cisplatin (M-VAC) in advanced urothelial tumors. J Urol 133:403–407PubMedGoogle Scholar
  11. 11.
    Logothetis CJ, Samuels ML, Ogden S et al. (1985) Cyclophosphamide, doxorubicin and cisplatin chemotherapy for patients with locally advanced urothelial tumors with or without nodal metastases. J Urol 134:460PubMedGoogle Scholar
  12. 12.
    Harker WG, Meyers FJ, Freiha FS et al. (1985) 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 3:1463–1470PubMedGoogle Scholar
  13. 13.
    Stoter G, Splinter TAW, Child JA et al. (1987) Combination chemotherapy with cisplatin and methotrexate in advanced transitional cell cancer of the bladder. J Urol 137:663–667PubMedGoogle Scholar
  14. 14.
    Logothetis CJ, Dexeus FH, Chong C et al. (1989) Cisplatin, cyclophosphamide and doxorubicin chemotherapy for unresectable urothelial tumors: the M.D. Anderson experience. J Urol 141:33–37PubMedGoogle Scholar
  15. 15.
    Sternberg CN, Yagoda A, Scher HI et al. (1989) M-VAC for advanced transitional cell carcinoma of the urothelium; efficacy, and patterns of response and relapse. Cancer 64:2448–2458PubMedCrossRefGoogle Scholar
  16. 16.
    Scher H (1989) Should single agents be standard therapy for urothelial tract tumors? J Clin Oncol 10:694–697Google Scholar
  17. 17.
    Loehrer PJ, Elson P, Kuebler JP et al. (1991) Advanced bladder cancer: A prospective Intergroup trial comparing single agent cisplatin (CDDP) versus M-VAC combination therapy (INT 0078). Proc Am Soc Clin Oncol 10(511): 132Google Scholar
  18. 18.
    Logothetis C, Dexeus F, Sella A et al. (1990) A prospective randomized trial comparing CISCA to MVAC chemotherapy in advanced metastatic urothelial tumors. J Clin Oncol 8:1050–1055PubMedGoogle Scholar
  19. 19.
    Lo Rk, Freiha FS, Torti FM (1989) CMV for metastatic urothelial tumors. In: Johnson DE, Logothetis CJ, von Eschenbach AC (eds) Systemic therapy for genitourinary cancers. Year Book, Chicago, pp 59–63Google Scholar
  20. 19a.
    Seidman AD, Scher HI (1991) The evolving role of chemotherapy for muscle infiltrating bladder cancer. Sem Onc 18:585–595Google Scholar
  21. 20.
    Meyers FJ, Palmer JM, Scudder SA (1989) The multimodality approach to invasive transitional cell carcinoma of the bladder. In: Rous SN (ed) Urology annual 1989. Appleton and Lange, East Norwalk, pp 117–130Google Scholar
  22. 21.
    Goldin A, Venditti JM, Humphreys SR et al. (1956) Influence of the concentration of leukemic inoculum on the effectiveness of treatment. Science 123:840PubMedCrossRefGoogle Scholar
  23. 22.
    Skipper HE, Schabel FM, Wilcox WS (1964) Experimental evaluation of potential anticancer agents. XII. On the criteria and kinetics associated with curability of experimental leukemia. Cancer Chemother Rep 35:1–9PubMedGoogle Scholar
  24. 23.
    Nativ O, Herr HW, Scher HI et al. (1990) Neoadjuvant chemotherapy and partial cystectomy for invasive bladder tumors. Proc Am Soc Clin Oncol 9: 572Google Scholar
  25. 24.
    Prout GR, Shipley WU, Kaufman DS et al. (1990) Preliminary results in invasive bladder cancer with transurethral resection, neoadjuvant chemotherapy and combined pelvic irradiation plus cisplatin chemotherapy. J Urol 144:1128–1136PubMedGoogle Scholar
  26. 25.
    Scher H, Herr H (1989) Is chemotherapy a new form of radical treatment in infiltrating tumor localized to the bladder? In: Khoury S, Murphy GP (eds) Therapeutic progress in urological cancers. Liss, New York, pp 563–582Google Scholar
  27. 26.
    Hall RW, Prout GR (1990) Staging of bladder cancer: Is the tumor, node, metastasis sytem adequate? Semin Urol 17:517–523Google Scholar
  28. 27.
    Herr HH (1987) Conservative management of muscle-infiltrating bladder cancer: Prospective experience. J Urol 138:1162–1163PubMedGoogle Scholar
  29. 28.
    Gospodarowicz M, Hawkins NV, Rawlings GA et al. (1989) Radical radiotherapy for muscle invasive transitional cell carcinoma of the bladder: failure analysis. J Urol 142:1448–1152PubMedGoogle Scholar
  30. 29.
    Fossa SD, Ous S, Berner A (1991) Clinical significance of the “palpable mass” in patients with muscle-infiltrating bladder cancer undergoing cystectomy after preoperative radiotherapy. Br J Urol 67:54–60PubMedCrossRefGoogle Scholar
  31. 30.
    Seidman A, Scher HI, Herr H et al. (1991) Survival of patients (Pts) with invasive (T2-4 N0 M0) bladder cancer treated with neoadjuvant methotrexate, vinblastine, adriamycin and cisplatin (MVAC) chemotherapy. 3rd International Congress on Neo-Adjuvant Chemotherapy, p 35Google Scholar
  32. 31.
    Shipley WU, Prout GR, Kaufman D, Perrone TL (1987) Invasive bladder carcinoma: the importance of initial transurethral surgery and other significant prognostic factors for improved survival with full-dose irradiation. Cancer 60 [Suppl 4a]:514–520PubMedCrossRefGoogle Scholar
  33. 32.
    Hryniuk W, Bush H (1984) The importance of dose intensity in chemotherapy of metastatic breast cancer. J Clin Oncol 2:1281–1288PubMedGoogle Scholar
  34. 33.
    Scher H, Herr H, Yagoda A et al. (1988) Neoadjuvant M-VAC (methotrexate, vinblastine, adriamycin and cisplatin): the effect on primary bladder tumors. J Urol 139:470–474PubMedGoogle Scholar
  35. 34.
    Scher H, Herr H, Sternberg C et al. (1989) Neoadjuvant chemotherapy for invasive bladder cancer: experience with the M-VAC regimen. Br J Urol 64:250–256PubMedCrossRefGoogle Scholar
  36. 35.
    McCullough DL, Cooper RM, Yeaman LD et al. (1989) Neoadjuvant treatment of stages T2 to T4 bladder cancer with cis-platinum, cyclophosphamide and doxorubicin. J Urol 141:849–852PubMedGoogle Scholar
  37. 36.
    Logothetis CJ, Samuels ML, Selig DE et al. (1985) Combined intravenous and intra-arterial cyclophosphamide, doxorubicin, and cisplatin (CISCA) in the management of select patients with invasive urothelial tumors. Cancer Treat Rep 69:33PubMedGoogle Scholar
  38. 37.
    Splinter TAW, Scher HI, EORTC-GU group et al. (1990) The prognostic value of the pT-category after combination chemotherapy for patients with invasive bladder cancer who underwent cystectomy. In: Splinter T, Scher HI (eds) Neoadjuvant chemotherapy of invasive bladder cancer. Liss, New York, pp 219–224Google Scholar
  39. 38.
    Studer UE, Ackermann D, Casanova GA, Zingg EJ (1988) A newer form of bladder substitute based on historical perspectives. Semin Urol 6:57–65PubMedGoogle Scholar
  40. 39.
    Logothetis CJ, Johnson DE, Chong C et al. (1988) Adjuvant cyclophosphamide, doxorubicin, and cisplatin chemotherapy for bladder cancer: an update. J Clin Oncol 6:1590–1596PubMedGoogle Scholar
  41. 40.
    Tannock IF (1990) Endpoints of clinical trials in invasive bladder cancer. Semin Oncol 17:619–627PubMedGoogle Scholar
  42. 41.
    Skinner DG, Daniels JR, Russell CA et al. (1991) The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial. J Urol 141:459–464Google Scholar
  43. 42.
    Splinter TAW, Jacqmin D, Trevor Roberts J et al. (1989) EORTC-GU Group Study 30851: A phase II study of upfront chemotherapy in patients with invasive bladder cancer. Proc Am Soc Clin Oncol 8:541Google Scholar
  44. 43.
    Kock NG, Nilson AE, Norlen L et al. (1978) Urinary diversion via a continent ileum reservoir: clinical experience. Scand J Urol Neprol 49 [Suppl]:23–31Google Scholar
  45. 44.
    Fossa SD, Heilo A, Bormer O (1990) Unexpectedly high serum methotrexate levels in cystectomized bladder cancer patients with ileal conduit treated with intermediate doses of the drug. J Urol 143:498–501PubMedGoogle Scholar
  46. 45.
    Scher H, Herr H, Sternberg C et al. (1990) M-VAC (methotrexate, vinblastine, adriamycin, and cisplatin) and bladder preservation. In: Splinter T, Scher HI (eds) Neo-adjuvant chemotherapy of invasive bladder cancer. Liss, New York, pp 179–186Google Scholar
  47. 46.
    Geller NL, Scher H, Parmar M et al. (1990) Trial design and statistics: Can we combine available data to evaluate the effects of neoadjuvant chemotherapy for invasive bladder cancer? Semin Oncol 17:628–634PubMedGoogle Scholar
  48. 47.
    Parmar M (1990) Trial design. In: Splinter T, Scher HI (eds) Neo-adjuvant chemotherapy of invasive bladder cancer. Liss, New York, pp 115–118Google Scholar
  49. 48.
    Dalesio O (1990) Trial design and statistics. In: Splinter T, Scher HI (eds) Neoadjuvant chemotherapy of invasive bladder cancer. Liss, New York, pp 57–64Google Scholar
  50. 49.
    Moore MJ, Tannock IF (1988) How expert physicians would wish to be treated if they developed genito-urinary cancer. Proc Am Soc Clin Oncol 7:118Google Scholar
  51. 50.
    Steeg PS, Bevilacqua G, Kopper L et al. (1988) Evidence for a novel gene associated with low tumor metastatic potential. J Natl Cancer Inst 80:200–203PubMedCrossRefGoogle Scholar
  52. 51.
    Fradet Y, Tardif M, Bourget L et al. (1990) Clinical cancer progression in urinary bladder tumors evaluated by multiparameter flow cytometry with monoclonal antibodies. Cancer Res 50:432–437PubMedGoogle Scholar
  53. 52.
    Gabrilove JL, Jakubowski A, Scher H et al. (1988) A study of recombinant human granulocyte colony stimulating factor in cancer patients at risk for chemotherapy-induced neutropenia. N Eng J Med 318:1414–1422CrossRefGoogle Scholar
  54. 53.
    Logothetis C, Dexeus F, Sella A et al. (1990) Escalated (ESC) MVAC (MTX 30mg/m2, adriamycin 60mg/m2, vinblastine 4mg/m2, cisplatin 100mg/m2) with recombinant human granulocytes macrophage stimulating factor [(rhGM-CSF) Schering Corp)] for patients (PTS) with advanced and chemotherapy (CHT) refractory urothelium tumors: a phase I study. J Natl Cancer Inst 82:667–672PubMedCrossRefGoogle Scholar
  55. 54.
    Ling V (1989) P-glycoprotein and multidrug resistance. Semin Oncol 16:156–165PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • H. I. Scher
    • 1
  1. 1.Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of MedicineMemorial Sloan-Kettering Cancer CenterNew YorkUSA

Personalised recommendations