Initial Intravenous Cis-Platinum Therapy: Improved Management for Invasive High Risk Bladder Cancer?

Abstract

Between August 1981 and December 1983, 50 patients with invasive high risk bladder cancer were treated initially with 100 mg. per m.2 cis-platinum intravenously in 2 doses with a 3-week interval, which was followed by definitive treatment (radiotherapy and/or cystectomy). High risk disease was defined on the basis of at least 2 of the following: invasion into or beyond the muscle (stages B2 to D1), grade III histology, large tumors and ureteral obstruction. Major symptomatic improvement was noted in 38 patients (76 per cent) after 1 to 2 doses of cis-platinum and 30 (60 per cent) had an objective response to cis-platinum. An objective response (complete or partial remission) was noted in 43 patients (86 per cent) after cis-platinum plus definitive treatment. The 12-month actuarial survival was 86 per cent and the 2-year actuarial survival was 80 per cent (although only 14 patients were entered in the study more than 2 years ago). The protocol was well tolerated, with nausea and vomiting being the most common side effects. There were no deaths related to treatment. Ten patients (20 per cent) died of cancer. The relevance of initial cis-platinum therapy in this management program is now being evaluated in a multicenter randomized trial.

Initial Combination Chemotherapy with Cisplatin, Methotrexate and Vinblastine in Locally Advanced Transitional Cell Carcinoma—Response Rate and Pitfalls

“…There is evidence that this therapy eased micturition disturbances, a common and important problem for patients with advanced bladder cancer. This reinforces the finding of other groups of the beneficial symptomatic effects of cisplatin-based chemotherapy (Raghavan et al, 1985;Fossi et al, 1990). It is difficult to estimate, however, how much of this symptomatic relief resulted from chemotherapy rather than reduction of the tumour by TUR, the use of concomitant supportive therapy, or improved analgesic therapy.…”

Adjuvant Systemic Chemotherapy after Complete Transurethral Resection of Superficially Invasive Bladder Carcinoma (T1 G3–4 and T2 G2–4)

“…Results of neoadjuvant chemotherapy are limited. Com plete remission could be achieved by DDP alone in 28% of superficial tumors [Needles et al, 1982] and 16% of invasive tumors [Fagg et al, 1984;Raghavan et al, 1985;Soloway et al, 1981]. By definition neoadjuvant therapy is followed by definitive treatment.…”

“…(1) 64% of 50 patients with blad der cancer in stage T2-3 survived for 2 years after DDP chemotherapy followed by radiotherapy; cystectomy was performed in cases with incomplete remission only [Raghavan et al, 1985]. (2) 60% of 39 patients with blad der cancer in stage T2-3 survived 2 years after high-dose MTX chemotherapy followed by TUR [Hall et al, 1984] .…”

Pre‐emptive (Neo‐adjuvant) Chemotherapy Prior to Radical Radiotherapy for Fit Septuagenarians with Bladder Cancer: Age Itself is not a Contra‐indication

“…Thus the management of cancer in patients older then 70 years is not a simple issue. In the case of bladder cancer, the dilemma has recently become greater with the apparent increase in reported response rates (and perhaps survival) through the use of more aggressive management programmes (Harker et al, 1985;Raghavan et al, 1985;Sternberg et al, 1985).…”