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Is There a Role for Salvage Chemotherapy for Recurrent Bladder Cancer After Radical Cystectomy?

By: Amy MacDonald, MS
Posted: Friday, August 19, 2022

Dai Koguchi MD, of Kitasato University School of Medicine, Tokyo, and colleagues investigated the effect of salvage cytotoxic chemotherapy in patients with bladder cancer experiencing recurrence after radical cystectomy. Published in BMC Urology, the authors’ retrospective analysis revealed three significant trends. First, liver metastasis and locally advanced disease are independent risk factors for inferior cancer-specific survival in patients who experience disease recurrence following radical cystectomy. Second, upon recurrence, cancer-specific survival was significantly improved in such high-risk patients when they received salvage cytotoxic chemotherapy instead of best supportive care. Finally, the therapeutic benefit of salvage cytotoxic chemotherapy did not appear to be related to a history of adjuvant chemotherapy.

The authors reviewed clinical data for 361 patients with bladder cancer treated with radical cystectomy between 1990 and 2015. (A total of 75 patients who had received neoadjuvant chemotherapy were excluded.) Of the remaining 286 patients, 86 experienced recurrence. These 86 patients were delineated according to whether they had received salvage cytotoxic chemotherapy or best supportive care after recurrence and further categorized based on their risk profile. A total of 68 of the 86 patients were identified as high risk because of liver metastases or locally advanced disease at recurrence.

Statistical analyses revealed that liver metastasis following radical cystectomy (hazard ratio [HR] = 2.13; 95% confidence interval [CI] = 1.7–3.85; P = .01) and locally advanced disease at the time of radical cystectomy (HR = 1.92; CI = 1.06–3.46; P = .03) were both independent risk factors for poor cancer-specific survival. Additionally, in the high-risk group, cancer-specific survival was significantly better for patients who received salvage cytotoxic chemotherapy than for those who received best supportive care, with median survival durations of 9.4 months and 2.4 months respectively (P = .005) According to the investigators, these analyses reinforce the potential value of salvage cytotoxic chemotherapy in patients with bladder cancer experiencing recurrence after radical cystectomy, even in the presence of liver metastasis or locally advanced disease.

Disclosure: The study authors reported no conflicts of interest.

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