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2019 GU Cancers Symposium: Adjuvant Sequential Chemotherapy Plus Radiotherapy vs Radiotherapy Alone for Locally Advanced Bladder Cancer

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Key Points

  • Two-year DFS for chemotherapy plus radiotherapy was 62% vs 48%, and 2-year OS was 71% vs 51%, respectively.
  • On multivariable analysis, chemotherapy plus radiotherapy was a significant predictor of improved DFS and OS.
  • Late-grade gastrointestinal toxicity was observed in five chemotherapy plus radiotherapy patients and six radiotherapy patients.

A phase III Egyptian trial presented by Zaghloul et al (Abstract 351) at the 2019 Genitourinary Cancers Symposium focused on the benefit of adjuvant chemotherapy in patients with locally advanced bladder cancer treated with postoperative radiotherapy. Researchers compared postoperative radiotherapy alone vs sequential chemotherapy plus postoperative radiotherapy after radical cystectomy in locally advanced bladder cancer.

Study Methods

One hundred and fifty-three patients were enrolled from 2002 to 2008 at the National Cancer Institute in Cairo. Patients with at least one of the following factors—≥ pT3b, grade 3 disease, and positive nodes—with negative margins after radical cystectomy plus pelvic node dissection were eligible. Radiotherapy was delivered using 3D conformal radiotherapy to the pelvis to 45 Gy in 1.5 Gy twice a day. The arm receiving chemotherapy plus radiotherapy received two cycles of gemcitabine/cisplatin before and after radiotherapy.

The primary endpoint was disease-free survival (DFS).

Findings

Median follow-up was 21 months for chemotherapy plus postoperative radiotherapy and 15 months for radiotherapy alone.

There were two local failures in the radiotherapy alone arm and none in the chemotherapy plus radiotherapy arm. Two-year DFS for chemotherapy plus radiotherapy was 62% vs 48%, and 2-year overall survival (OS) was 71% vs 51%, respectively.

On multivariable analysis, chemotherapy plus radiotherapy was a significant predictor of improved DFS (hazard ratio [HR] = 0.42; confidence interval [CI] = 0.21–0.85, P = .016) and OS (HR = 0.45, 95% CI = 0.21–0.96, P = .039.

Late-grade gastrointestinal toxicity was observed in five chemotherapy-plus-radiotherapy patients and six radiotherapy patients.

The authors concluded, “The addition of adjuvant chemotherapy to postoperative radiotherapy improved DFS and OS for [patients with] locally advanced bladder cancer after radical cystectomy with acceptable late gastrointestinal toxicity. The results suggest a role for adjuvant therapies to address both local and distant disease.”

Disclosure: The study authors' full disclosures can be found at coi.asco.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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