Exploring Multimodal Treatment for Urothelial Cancer

Sophia Kamran, MD, a radiation oncologist at Massachusetts General Hospital and assistant professor of Radiation Oncology at Harvard Medical School, discusses the research supporting the use of trimodality therapy for patients with urothelial cancer.

Kamran recently gave a presentation on the subject during the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium. The strategy involved the use of transurethral resection of the bladder tumor, radiotherapy, and chemotherapy. In clinical trials so far, trimodality therapy appears to be blaring sparing, and safe for patients with urothelial cancer.

Transcription:

0:08 | There have been a lot of different types of trials involving chemoradiation, or trimodality therapy evaluating it in the United States, Europe, and across the globe, really. From all the trials that we have, it has been shown that it is as effective as radical cystectomy in well selected patients. Now, there has never been a head-to-head randomized trial or comparison between radical cystectomy and trimodality therapy. There have been attempted trials, but they didn't accrue, unfortunately. At this time, we don't think we're going to be able to have a direct head-to-head comparison, but this is probably the best data that we will have to date, at least at this time.

0:51 | From all of the data that we have now and what was recently presented at the Genitourinary Cancer Symposium, which is probably the best evidence to date and used a very large pooled database of patients that had radical cystectomy, or trimodality therapy, they did propensity score matching, and from that, it gives us more data showing that true modality is as effective as radical cystectomy in modern series. It's very reassuring and NCCN guidelines have adopted it as being an equivalent option to radical cystectomy for patients with muscle invasive bladder cancer.

1:47 | Now the second question with regards to safety, that has been investigated in their earlier trials. One of the big questions was late pelvic toxicity. If you're keeping the bladder in a patient, is it even worthwhile doing or do patients really struggle? That's the main question, as otherwise, we wouldn’t want to spare the bladder. From a pooled analysis of 4 RTOG trials evaluating patients that didn't maintain their bladder, they underwent trimodal therapy, and they were followed. In terms of late pelvic toxicity, it was very low. This was also very reassuring.