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Muscle-Invasive Bladder Cancer: Comparing Trimodal Therapy and Radical Cystectomy

By: Joseph Fanelli
Posted: Friday, September 3, 2021

For patients with muscle-invasive bladder cancer, trimodal therapy using a chemotherapy regimen preferred by the National Comprehensive Cancer Network (NCCN) appears to yield similar outcomes to treatment with radical cystectomy, particularly for patients aged 65 and older, according to findings presented in European Urology Open Science. However, Tyler F. Stewart, MD, of the University of California San Diego, and colleagues reported poorer survival outcomes for patients younger than age 65 or who were treated with trimodal therapy in combination with a therapy regimen not preferred by the NCCN.

“Our data highlight that trimodal therapy is an effective treatment option and should be considered for patients who are unable or unwilling to pursue cystectomy,” the investigators commented.

In this study, the authors used data from the U.S. Veteran Affairs Healthcare System to evaluate 2,306 patients with nonmetastatic muscle-invasive bladder cancer. Of them, 1,472 received radical cystectomy without neoadjuvant chemotherapy, 506 had radical cystectomy with neoadjuvant chemotherapy, 163 had trimodal therapy with an NCCN-preferred chemotherapy, and 165 had trimodal therapy with an NCCN-nonpreferred chemotherapy.

The authors found that patients who received trimodal therapy with a preferred chemotherapy had similar overall mortality rate (hazard ratio [HR] = 1.19) and bladder cancer–specific mortality rates (HR = 1.34) as those patients who underwent radical cystectomy without neoadjuvant chemotherapy. Trimodal therapy with nonpreferred chemotherapy was associated with a worse overall and bladder cancer–specific mortality rate.

For patients at least 65 years old, treatment with trimodal therapy and a preferred chemotherapy was associated with similar overall and bladder cancer–specific mortality rates to those who underwent radical cystectomy and neoadjuvant therapy. A worse overall mortality rate (HR = 1.82) and bladder cancer–specific mortality rate (HR = 2.51) was found for patients younger than age 65 who received trimodal therapy and a preferred chemotherapy. The 5-year cumulative incidence of salvage cystectomy in the trimodal therapy cohort was 3.6%.

Disclosure: For full disclosure of the study authors, visit sciencedirect.com.



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