ASCO GU 2022 | Radical cystectomy vs. trimodality therapy for muscle-invasive bladder cancer
Alexandre R. Zlotta, MD, PhD, Mount Sinai Hospital and University of Toronto, Toronto, Canada, discusses a study which compared outcomes of patients with muscle-invasive bladder cancer who were treated with radical cystectomy or trimodality therapy. All patients in the study were eligible for either treatment option, but these patients represent 30-40% of patients with muscle-invasive bladder cancer in general. The study found that trimodality therapy achieved the same survival rate as radical cystectomy in these patients. This interview took place at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium 2022 in San Francisco, CA.
Transcript (edited for clarity)
Well, in this study, we’ve compared the outcomes of patients who are treated with bladder sparing approach, which is trimodality, which is combination of TURBT resecting the tumor, and then giving radiation therapy with a chemosensitizing agent. The gold standard has been, in the past, radical cystectomy. And therefore we compare it to patients who had been eligible for both treatment options in a multicentric study in Toronto, Boston, and Los Angeles...
Well, in this study, we’ve compared the outcomes of patients who are treated with bladder sparing approach, which is trimodality, which is combination of TURBT resecting the tumor, and then giving radiation therapy with a chemosensitizing agent. The gold standard has been, in the past, radical cystectomy. And therefore we compare it to patients who had been eligible for both treatment options in a multicentric study in Toronto, Boston, and Los Angeles.
And we actually matched patients who would’ve been eligible to be treated by both treatment options and then analyzed their survival, met free survival and other outcomes. And the study showed that TMT offered exactly the same oncological survival than radical cystectomy. But there is a limitation for that, is that we selected specific patients in which means that by no means, we’re saying that all the patients with muscle invasive bladder cancer would benefit.
These were patients with tumors, less than seven centimeters, unilateral, no carcinoma extensive in situ, where there’s a genetic instability of the interior bladder, no hydronephrosis swelling of one of the ureters and a good bladder function. And so usually this represents about 30 to 40% of patients, but in these patients, indeed, this is the largest trial so far, which allows us to affirm and establish TMT as a very valid treatment option for these patients.
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