A study published by Strother et al in BJU International found that patients with muscle-invasive bladder cancer can safely receive cisplatin-based neoadjuvant chemotherapy, even when their tumors are blocking their kidneys. The findings suggest that patients with the most serious type of this common cancer can receive potentially life-extending treatment—usually without the need for additional invasive procedures.
“What this shows is that in many cases you don’t need to unblock the kidneys before giving chemotherapy,” said Marshall C. Strother, MD, a urologic oncology fellow at Fox Chase Cancer Center and lead author of the study. “This will hopefully save a lot of patients some unnecessary procedures down the road.”
Muscle-invasive bladder cancer makes up about a quarter of bladder cancer cases and is more deadly, with about a 50% 5-year survival rate. Giving these patients chemotherapy prior to surgery has shown to significantly improve survival rates.
Inserting a stent to unblock the kidneys is not only invasive, but can also raise the risk of additional problems, and there is some indication that it could increase the risk of cancer recurrence, explained Dr. Strother. About one in three patients with invasive bladder cancer experience ureteric obstruction, raising concerns about their ability to tolerate the powerful chemicals used in chemotherapy. Until now, there has been little guidance for how to treat these patients, and the approach varies from oncologist to oncologist.
Analysis Results
The research team studied a database of 277 patients with muscle-invasive bladder cancer who received the chemotherapy cisplatin prior to undergoing surgery.
Of the 193 patients included in the study, some had no kidney blockage, some had a blockage that was removed prior to chemotherapy, and others went through chemotherapy without having the blockage removed.
The results showed that there was no significant difference between the three groups in their ability to tolerate chemotherapy.
“These patients can get chemotherapy...” said Dr. Strother. “And actually, as it turns out, the chemotherapy itself does a pretty good job of killing off cancer cells so that the kidney becomes unblocked.”
The findings are encouraging, because if a patient’s cancer has progressed to the point where it is blocking a kidney, it’s an indication that the cancer is more aggressive. These are precisely the patients who could benefit most from receiving chemotherapy prior to surgery, noted Dr. Strother. Kidney blockage is a common problem with a variety of cancers, so the findings could be relevant beyond bladder cancer, he noted.
The study authors concluded, “Patients with ureteric obstruction can safely receive cisplatin-based neoadjuvant chemotherapy. Relief of obstruction was not associated with increased safety of cisplatin-based neoadjuvant chemotherapy delivery.”
Disclosure: For full disclosures of the study authors, visit bjui-journals.onlinelibrary.wiley.com.
