Bladder cancer patients given low doses of chemotherapy combined with radiotherapy are nearly 50% less likely to relapse with the most lethal form of the disease, compared to those given radiotherapy alone, a major trial funded by Cancer Research UK has shown.
The success of the trial – led by The Institute of Cancer Research (ICR) and the University of Birmingham – could mean fewer patients need their bladder removed and provides a viable alternative for frailer patients who are too weak for surgery.
Study co-leader Professor Nick James from the University of Birmingham, said: “Bladder cancer is largely a disease of older people and is also linked to smoking, meaning patients are often in relatively poor general health when diagnosed. Removing the bladder is still one of the most effective ways of treating invasive cancer that has spread to the muscle of the bladder. But this can be very distressing and we know patients are often too frail for such radical surgery.
“The alternative is to give radiotherapy, but around a third of these patients will go on to relapse with invasive disease and will need their bladder removed anyway. So these results really provide a lifeline for those too old or weak for surgery and mean that, in future, fewer patients will need their bladder removed.”
Three hundred and sixty patients from around the UK were included in the study. Around half were given two commonly used chemotherapy drugs – fluorouracil and mitomycin C – in addition to the radiotherapy treatment.
Thirty-three per cent of patients receiving chemotherapy in addition to radiotherapy (known as chemoradiotherapy) had a relapse within their bladder or surrounding tissues within two years, compared to 46% of those who had radiotherapy alone. Of those who received chemoradiotherapy, around one in five developed invasive cancer – the most serious form of the disease – compared to around one in three among those who had radiotherapy alone.
Early results also showed that combining radiotherapy with chemotherapy may improve survival, with 48% of patients still alive after five years, compared to 35% of those who had radiotherapy alone, although larger studies are needed to confirm this.
Study co-leader Dr Robert Huddart from the ICR and The Royal Marsden NHS Foundation Trust, added: “Removing the bladder is a major operation with implications for the rest of the patient’s life. We found that adding chemotherapy to radiotherapy successfully lowered the risk of relapse sufficiently to make it a real option for patients who don’t wish to have radical surgery and lose their bladder. Importantly, these improvements have been achieved with drugs that are cheap and widely available, and carry few additional side-effects over radiotherapy alone.”
The results of the trial have been published in the New England Journal of Medicine.
