Better integration of chemotherapy and surgery could lead to a long-awaited improvement in bladder cancer survival, according to new research presented in Sydney on Monday, 16 July 2012 by a visiting US expert in urogenital cancers.
Speaking at the Australian and New Zealand Urogenital and Prostate (ANZUP) annual scientific meeting, New York-based urologist and oncologist Professor Shahrokh Shariat says while removal of affected tissue is the traditional way to treat bladder cancer, the model is being challenged by new clinical trials data.
“Bladder cancer is a biologically aggressive disease with a high propensity to spread to other organs. Removing the visible cancer alone is often insufficient,” Professor Shariat says.
Bladder cancer is often described as “a disease of older people”. The Cancer Council Australia website reports bladder cancer is more common in men, with the risk of bladder cancer by the age of 85 being one in 44 for men, compared to one in 154 for women.
Professor Shariat reveals a growing body of evidence shows perioperative chemotherapy – administered immediately before and after surgery – can possibly slow the advance of bladder cancer.
“At present, this only occurs in individual clinical trials. We need more trials and more data if we are to change practice and ultimately improve outcomes for a wider range of patients – not just those participating in trials.”
He adds most current clinical trials continue to use extensive patient populations that include many patients who are unlikely to respond to a targeted treatment because their cancer does not have the relevant molecular defects, and thereby unnecessarily endure its side effects.
To ensure higher chances of benefit, Professor Shariat recommends designing trials that will include “smaller patient populations who harbor relevant genetic and epigenetic defects measured by validated biomarker signatures”.
ANZUP Chair, Melbourne-based medical oncologist and researcher, Professor Ian Davis, says Professor Shariat’s work shows the importance of clinical trials to improving cancer survival.
“The potential for the research to improve bladder cancer survival – which is the least-improved in Australia – is a compelling case for funding independent clinical trials,” Professor Davis says.
“Urogenital and prostate cancers are among the most challenging to treat in relation to clinical practice and quality of life,” he adds.