Chemotherapy after bladder cancer surgery improves survival

Patients who received chemotherapy after bladder cancer surgery demonstrated an approximately 30% lower risk of death than those who underwent surgery alone. This analysis was presented at the 2015 Genitourinary Cancers Symposium in Orlando, Florida.

Clinical trials have established the benefit of giving chemotherapy prior to surgery (neoadjuvant chemotherapy) for patients with bladder cancer. However, clinical trials exploring giving chemotherapy after surgery (adjuvant chemotherapy) have been difficult to interpret and many of the trials closed early due to poor accrual without providing an answer.

Lead researcher Matthew Galsky, MD, and colleagues from the Icahn School of Medicine at Mount Sinai in New York, New York, used a large database of patients with a cancer diagnosis in the United States. Specifically, the study found that patients receiving adjuvant chemotherapy after surgery had improved overall survival compared with patients who underwent surgery with only postsurgical observation.

"Until now, data supporting adjuvant chemotherapy has been mixed," said Galsky, associate professor of medicine, Hematology and Medical Oncology, and assistant professor, Urology at the Icahn School of Medicine at Mount Sinai. "Our analysis of actual cases supports the use of chemotherapy after surgery for patients with locally advanced bladder cancer."

Of the 5,653 patients analyzed, 1,293 patients received adjuvant chemotherapy versus 4,360 patients who received surgery alone.

"Chemotherapy prior to surgery remains the optimal approach for patients with bladder cancer based on the available evidence. However, population-based observational studies may be used to help fill the knowledge void in situations where clinical trials have not yielded definitive evidence. This comparative effectiveness analysis may help inform the care of patients with bladder cancer who have not received chemotherapy prior to surgery," Galsky said.

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