Second-line chemotherapy for advanced bladder cancer: a survey of current UK practice

Abstract

Objectives: To understand current practice of the treatment of advanced bladder cancer in the United Kingdom, and in particular, the use of second-line chemotherapy.To gain insight into uro-oncologists' use of first-line chemotherapy, imaging following first-line chemotherapy, use of second-line chemotherapy, and the role of the multidisciplinary tumor board (MTB) in making decisions about second-line chemotherapy.

Materials and methods: From August 2011 to September 2011 uro-oncologists from UK cancer centers were surveyed regarding treatment of advanced bladder cancer.Delegates at the British Uro-oncology Group conference were invited to fill out an electronic survey.

Results: Uro-oncologists from 28 of 42 UK cancer centers (67%) participated, who treated, on average 45 patients per year with advanced bladder cancer.Fifteen "always" reimage after first-line chemotherapy, mostly "after 2-4 cycles." Symptomatic patients with progressive distant disease on imaging were most likely to trigger second-line chemotherapy (P = 0.004).Twenty-one respondents would interrupt first-line chemotherapy to start second-line chemotherapy for progressive disease and 10 would never do this. Of the patients given first-line chemotherapy, 19% go on to receive second-line chemotherapy.Seven different regimes were specified for second-line chemotherapy with no clear preference. National Institute for Health and Clinical Excellence approval, trial data, inclusion in hospital formulary, clinical trials, or commissioning guidelines, and easy access to imaging help to access second-line chemotherapy (P ≤ 0.001). Constraints to second-line chemotherapy were lack of evidence and patient comorbidities.MTB effectiveness did not improve access to second-line chemotherapy. Of the 33 respondents, 19 do not rediscuss patients at the MTB before starting second-line chemotherapy.

Conclusion: The investigation and treatment of patients with advanced bladder cancer following first-line chemotherapy is variable.Optimizing the modality and frequency of imaging and increasing the usefulness of the MTB process may improve care.

Keywords: Advanced; Bladder cancer; Chemotherapy; Imaging; Multidisciplinary; Second-line; Tumor Board.