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New Bladder Cancer Treatments Increase Life Expectancy in Advanced Bladder Cancer

New Bladder Cancer Treatments Increase Life Expectancy in Advanced Bladder Cancer

ANAHEIM, California—A phase III Intergroup trial has provided
strong evidence that neoadjuvant MVAC—methotrexate, vinblastine, doxorubicin
(Adriamycin), cisplatin (Platinol)—provides a survival benefit in patients
with locally advanced bladder cancer, David Crawford, MD, said at the American
Urological Association (AUA) annual meeting (abstract 1069).

Dr. Crawford is professor of urologic oncology, University of Colorado
Cancer Center, Denver. [The study, not previously reported in ONI, was also
presented at the 2001 ASCO annual meeting plenary session (abstract 3).]

Although cystectomy and removal of surrounding lymph nodes provides the best
survival benefit for patients with advanced bladder cancer, about 60% of these
patients harbor micrometastases and die of their disease. The only therapy that
has proved superior to cisplatin alone in patients with grossly advanced
metastatic disease is MVAC.

Neoadjuvant MVAC

This study, by SWOG, ECOG, and CALGB, aimed to determine if three cycles of
MVAC followed by cystectomy would improve survival in patients treated at an
earlier stage. SWOG 8710 (Intergroup 0080) was a randomized phase III trial of
neoadjuvant MVAC followed by cystectomy vs cystectomy alone in 307 patients
evaluated over a 14-year period. Patients had T2-4a, N0, M0 transitional cell
carcinomas and were stratified according to age and stage.

Dr. Crawford reported that survival was 2.4 years longer for patients
receiving neoadjuvant MVAC, compared with those who underwent surgery alone.
With median follow-up of 7.1 years, 128 patients remain alive, with 85 and 94
deaths, respectively, in the MVAC and no MVAC arms. Estimated median survivals
are 6.2 years and 3.8 years, respectively, and the hazard ratio is 0.74 for
patients receiving MVAC (P = .027).

Additionally, pathologic examination of the bladder after cystectomy
revealed that 38% of patients receiving MVAC had no evidence of remaining
disease. Among these patients, 85% were still alive 5 years after surgery.

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