乌鸦传媒

Radical cystectomy remains the preferred treatment option for Bacillus Calmette-Guerin (BCG)-unresponsive or BCG-intolerant patients with American Urological Association high-risk group non-muscle invasive bladder cancer, according to the National Comprehensive Cancer Network guidelines. In select patients, alternatives to cystectomy include intravesicular chemotherapy, pembrolizumab, nadofaragene firadenovec, and nogapendekin alfa inbakicept with BCG.

Dahl, et al. has authored a new evaluating bladder-preserving trimodality treatment as an alternative to cystectomy in patients for whom BCG has failed. In this study trimodality therapy consisted of a maximal transurethral resection of bladder tumor (TURBT) followed by conventional radiation therapy to the bladder, delivering 61.2 Gy in 34 fractions (over about 7 weeks) combined with radiosensitizing chemotherapy that included either cisplatin or fluorouracil with mitomycin.

This was a small, single-arm, phase II study that enrolled 37 patients between 2009 and 2023. Median patient age was 74 years, with 91.2% being male and 94.1% being Caucasian. The study met its primary endpoint, which was 3-year freedom from cystectomy rate of 88.0%. Key secondary endpoints included overall survival at 3 and 5 years, which were 69.0% and 56%, respectively.

Meanwhile, distant metastasis rates at 3 and 5 years were 12% and 19%, respectively, with 8 patients ultimately dying of distant disease.

No unexpected toxicities were noted, with 18 patients within the evaluable study population experiencing grade 3 or higher adverse events -- mostly hematological in nature. Other observed toxicities included gastrointestinal events, urinary tract infections, hematuria, and metabolic/nutritional events.

Overall, this study highlights trimodality bladder-preserving therapy as a possible option for patients with recurrent T1 urothelial carcinoma of the bladder post-BCG failure.

It would be interesting to further investigate the concept of bladder preservation using modern radiation techniques and novel chemotherapy-sparing radiation-sensitizing agents.

Nataliya Mar, MD, is associate clinical professor in the Division of Hematology/Oncology at the School of Medicine, Chao Family Comprehensive Cancer Center, University of California Irvine Health.

Read the study here and an interview about it here.