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. 2014 Jul;32(5):637-44.
doi: 10.1016/j.urolonc.2013.12.012. Epub 2014 May 16.

Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States

Andrea B Apolo  1 , Joseph W Kim  2 , Bernard H Bochner  3 , Seth M Steinberg  4 , Dean F Bajorin  5 , Wm Kevin Kelly  6 , Piyush K Agarwal  7 , Theresa M Koppie  8 , Matthew G Kaag  9 , David I Quinn  10 , Nicholas J Vogelzang  11 , Srikala S Sridhar  12
Affiliations

Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States

Andrea B Apolo et al. Urol Oncol. 2014 Jul.

Abstract

Background: Neoadjuvant chemotherapy (NACT) for the treatment of muscle-invasive bladder cancer (MIBC) remains underutilized in the United States despite evidence supporting its use.

Objectives: To examine the perioperative chemotherapy management of patients with MIBC by medical oncologists (MedOncs) to move toward standardization of practice

Participants and methods: A 26-question survey was emailed to 92 MedOncs belonging to the Bladder Cancer Advocacy Network or the American Society of Clinical Oncology for completion from May to October 2011 RESULTS: A total of 83 MedOncs completed the survey: 52% were based in academic centers. Most referrals were from urologists (79%). NACT for treatment of MIBC and high-grade upper-tract urothelial carcinoma is offered by 80% and 46% of respondents, respectively. Adjuvant chemotherapy for treatment of MIBC and upper-tract urothelial carcinoma is offered by 46% and 42% of respondents, respectively. NACT was not offered by 49%, 29%, and 35% of respondents if Eastern Cooperative Oncology Group performance status was 3 or greater, if patients had T2 lesions without lymphovascular invasion, and if the glomerular filtration rate was<50ml/min, respectively. Chemotherapy regimens included gemcitabine/cisplatin (90%), methotrexate/vinblastine/adriamycin/cisplatin (30%), dose-dense methotrexate, vinblastine, adriamycin, and cisplatin (20%), and gemcitabine/carboplatin (37%).

Conclusions: Most MedOncs (79%) in this survey offer perioperative chemotherapy to all patients with MIBC. This increased use of NACT is higher than previously reported, suggesting an increase in the adoption of recommendations that follow best evidence.

Keywords: Adjuvant chemotherapy; Medical oncologist; Muscle-invasive bladder cancer; Neoadjuvant chemotherapy; Survey.

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Figures

Fig. 1.
Fig. 1.
Percentage of responses to questions about perioperative chemotherapies in bladder cancer and patients with upper-tract urothelial cancer. (A) Do you offer neoadjuvant chemotherapy? (B) Do you offer neoadjuvant chemotherapy to patients with upper-tract (renal pelvis or ureter) urothelial cancer? (C) Do you offer adjuvant chemotherapy? (D) Do you offer adjuvant chemotherapy to patients with upper-tract (renal pelvis or ureter) urothelial cancer?
Fig. 2.
Fig. 2.
Percentage of responses to questions about perioperative chemotherapies in bladder cancer and patients with upper-tract urothelial cancer, divided by academic vs. community participants. (A) Do you offer neoadjuvant chemotherapy? (B) Do you offer neoadjuvant chemotherapy to patients with upper-tract (renal pelvis or ureter) urothelial cancer? (C) Do you offer adjuvant chemotherapy? (D) Do you offer adjuvant chemotherapy to patients with upper-tract (renal pelvis or ureter) urothelial cancer?
Fig. 3.
Fig. 3.
The estimated relative distribution of perioperative chemotherapies.
Fig. 4.
Fig. 4.
When do you NOT give neoadjuvant chemotherapy? (n = 68). (A) At what functional status would you NOT recommend neoadjuvant chemotherapy? (B) At what GFR value would you NOT recommend neoadjuvant chemotherapy? (C) At what age would you NOT recommend neoadjuvant chemotherapy?
Fig. 5.
Fig. 5.
(A) Adjustments of chemotherapy for renal insufficiency. (B) Management of pathologic residual disease after neoadjuvant chemotherapy.
See this image and copyright information in PMC

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