Αρχική World News New Treatment Approach Could Help Prevent Recurrences of Some Bladder Cancers

New Treatment Approach Could Help Prevent Recurrences of Some Bladder Cancers

May 31, 2018, by NCI Staff

Low-grade, or stage I, bladder cancer has not invaded the muscle layers of the bladder.

Credit: National Cancer Institute

Flushing the bladder with the chemotherapy drug gemcitabine (Gemzar) after tumors have been removed surgically may reduce the risk of the cancer returning, according to the results of a large clinical trial.

In the trial, patients with low-grade nonmuscle-invasive bladder cancer who received a single dose of gemcitabine in the bladder through a catheter after surgery were much less likely to experience a recurrence of the disease within 4 years than patients who received a placebo.

Low-grade bladder cancers recur frequently, and recurrences require treatment with a procedure called transurethral resection for bladder tumor, or TURBT. Some patients experience multiple recurrences and, as a result, undergo repeated surgeries.

“This surgery is one of the most common operations done in urology,” said Edward Messing, M.D., of the University of Rochester School of Medicine and Dentistry, who led the trial. “It’s expensive, and it is difficult for many patients with bladder cancer, who tend to be older and have other health conditions.”

Among all of the 406 patients in the clinical trial, the use of gemcitabine after surgery reduced the rate of the cancer returning. Over 4 years, the recurrence rate was 35% in the gemcitabine group, compared with 47% in the placebo group, the researchers reported in JAMA on May 8.

Participants were recruited and randomly assigned to a treatment group prior to undergoing surgery, which is needed to determine whether a patient has low-grade or high-grade disease. Over the course of the trial, the researchers determined that 215 patients had low-grade disease.

Among this group, 34 of 102 patients receiving gemcitabine (34%) had a recurrence, compared with 59 of 113 patients receiving placebo (54%)—a 37% relative reduction in the recurrence rate.

“Based on these results,” Dr. Messing said, “the addition of gemcitabine after surgery should be the new standard of care for patients with low-grade bladder cancer.”

An editorial accompanying the study agreed. The gemcitabine-based approach is a “simple, safe, effective, and affordable innovation in the treatment of bladder cancer,” wrote Matthew Nielsen, M.D., director of Urologic Oncology at the University of North Carolina School of Medicine, and several colleagues.

Another Option for Reducing Recurrences

Other studies have demonstrated that giving patients with low-grade bladder cancer the chemotherapy drug mitomycin C through a catheter following surgery can reduce the chance of a recurrence. These studies led professional groups in the United States and Europe to recommend this approach for patients with low-grade disease that has not invaded the muscle.

In the United States, however, few patients receive this treatment, in part because of concerns about the side effects of mitomycin C, as well as the availability and cost of the drug, noted Dr. Messing. Mitomycin C can be toxic if it leaks out of the bladder through a hole, and the drug can also cause severe rashes when it comes in contact with skin.

Gemcitabine, on the other hand, is a well-tolerated, readily available drug that “comes at relatively little cost in terms of side effects or expense,” said Dr. Messing. The side effects were similar between the two groups in the trial and were generally manageable, he added.

Some patients with advanced bladder cancer already receive gemcitabine, noted Piyush Agarwal, M.D., who heads the Bladder Cancer Section in NCI’s Center for Cancer Research and was not involved in the trial. “So, it makes sense that the drug would be used to treat patients with low-grade bladder cancer.”

By delivering gemcitabine directly into the bladder—a technique called intravesical instillation—the drug can affect cells lining the bladder without causing side effects in other parts of the body, he explained.

Dr. Agarwal predicted that the new study would lead to revisions in treatment guidelines to include gemcitabine as an option for reducing recurrences in the patients with low-grade bladder cancer.

“It’s very clear from the trial that patients with low-grade bladder cancer benefited from the use of gemcitabine,” he said, noting that patients with high-grade disease were not harmed by the addition of gemcitabine, but neither did they benefit.

For his own patients with low-grade bladder cancer, Dr. Agarwal plans to start using gemcitabine after surgery.

Selecting and Testing Gemcitabine

When Dr. Messing began research on gemcitabine as a possible way to reduce recurrences more than a decade ago, the drug was not widely used for bladder cancer. “We tried to pick an agent that we thought would be safe and effective,” he said.

The researchers decided to compare gemcitabine against placebo rather than mitomycin C, based on studies showing how infrequently patients received some form of chemotherapy following surgery despite guidelines recommending this approach.

“If the new procedure were adopted widely, we could spare patients a lot of suffering from repeated surgeries and save health care costs associated with those surgeries,” Dr. Messing said.

“Now that we have the results of the trial,” he went on, “we hope that patients and physicians will embrace this approach to treatment.”

Source

NEWSLETTER

Συμπληρώστε το email σας για να λαμβάνετε τις σημαντικότερες ειδήσεις από το ogkologos.com

Βρείτε μας

2,449ΥποστηρικτέςΚάντε Like
57ΑκόλουθοιΑκολουθήστε

Διαβαστε Επίσης

Καρκίνος και Κορωνοϊός (COVID-19) ΜΕΡΟΣ Α

Εάν είστε καρκινοπαθής, το ανοσοποιητικό σας σύστημα μπορεί να μην είναι τόσο ισχυρό όσο κανονικά, έτσι μπορεί να ανησυχείτε για τους κινδύνους που σχετίζονται...

ΠΑΓΚΟΣΜΙΑ ΗΜΕΡΑ ΚΑΡΚΙΝΟΥ

Η Παγκόσμια Ημέρα Κατά του Καρκίνου καθιερώθηκε με πρωτοβουλία της Διεθνούς Ένωσης κατά του Καρκίνου (UICC), που εκπροσωπεί 800 οργανώσεις σε 155 χώρες του...

ΕΞΕΛΙΞΕΙΣ ΣΤΗ ΘΕΡΑΠΕΙΑ ΤΟΥ ΜΗ-ΜΙΚΡΟΚΥΤΤΑΡΙΚΟΥ ΚΑΡΚΙΝΟΥ ΤΟΥ ΠΝΕΥΜΟΝΑ (ΜΜΚΠ)

ΕΞΕΛΙΞΕΙΣ ΣΤΗ ΘΕΡΑΠΕΙΑ ΤΟΥ ΜΗ-ΜΙΚΡΟΚΥΤΤΑΡΙΚΟΥ ΚΑΡΚΙΝΟΥ ΤΟΥ ΠΝΕΥΜΟΝΑ (ΜΜΚΠ) Γράφει ο Δρ Παπαδούρης Σάββας, Παθόλογος-Ογκολόγος   Ο ΜΜΚΠ βρίσκεται αναλογικά στο 80% και πλέον του συνολικού...

Διατρέχουν όντως οι καρκινοπαθείς μεγαλύτερο κίνδυνο λόγω κοροναϊού;

Σε πρακτικό επίπεδο, τα δεδομένα των σχετικών μελετών υποδηλώνουν ότι η χημειοθεραπεία ή οι άλλες αντι-νεοπλασματικές θεραπείες δεν αυξάνουν σημαντικά τον κίνδυνο θνησιμότητας από...

FDA: Η ακτινοβολία των smartphones δεν προκαλεί καρκίνο

Σε μια νέα έκθεσή της, η Υπηρεσία Τροφίμων και Φαρμάκων (FDA) των ΗΠΑ αναφέρει ότι επανεξέτασε τις σχετικές επιστημονικές έρευνες που δημοσιεύθηκαν τα τελευταία...

Νέα ανακάλυψη, νέα ελπίδα για τον καρκίνο

Ένα νεοανακαλυφθέν τμήμα του ανοσοποιητικού μας συστήματος θα μπορούσε να αξιοποιηθεί για την αντιμετώπιση όλων των ειδών καρκίνου, σύμφωνα με επιστήμονες του πανεπιστημίου Cardiff...
- Advertisment -

Ροή Ειδήσεων

Overall Breast Cancer Incidence Down Since 1999, Rates Increase for Women Under 40

U.S. breast cancer death rates decreased by about 1% per year between 2013 and 2018. What were the new case rates during that same...

Impressive Responses to PD-1 Blockade in a Large Cohort of Children and Young Adults with Recurrent/Progressive Germline DNA Replication Repair-Deficient Cancers

A large, observational, registry-based study that leveraged systematically collected data gathered both retrospectively and prospectively through the International Replication Repair Deficiency Consortium reveals impressive...

2-Year-Boy Is So Excited To See Himself In Disney’s ‘Encanto’

The importance of representation in media has been a growing topic of concern, and companies have responded by adding more diversity to their characters,...

Man Walks Entire Continent To Spread Awareness About Mental Health & Suicide Prevention

Matthew Fennell is walking over 3,000 miles across Australia for an important cause and one that is near and dear to his heart. Last year,...

Boy Battling Cancer Becomes Honorary Police Officer, Sworn In To 45 Agencies

At just ten years old, Devarjaye “DJ” Daniel has already been through more than most people go through in their entire lives. DJ has been...

Paclitaxel and Carboplatin Not Inferior When Compared with Paclitaxel and Ifosfamide for the Treatment of Patients with Uterine Carcinosarcoma

With regard to overall survival (OS), paclitaxel and carboplatin was not inferior and demonstrated improved progression-free survival (PFS) when compared with paclitaxel and ifosfamide...