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November 2023 | George M. Pikler, M.D., Ph.D., FACP

Organ-Sparing Treatment Succeeds in Trial

Radical cystectomy is a standard treatment for muscle-invasive bladder cancer (MIBC). However, radical cystectomy is a life-changing operation due to the need for urinary diversion and is associated with a 90-day mortality risk of up to 6–8%.

Neoadjuvant cisplatin-based chemotherapy before radical cystectomy confers improved survival in patients with MIBC. Although the intent of neoadjuvant chemotherapy is eradication of micrometastatic disease, neoadjuvant cisplatin-based chemotherapy after transurethral resection of bladder tumor (TURBT) yields a pathological complete response (pCR) at the time of cystectomy in approximately 30% of patients. Paradoxically, a pCR can be determined only after the bladder has been surgically removed.

Given the potential to achieve a pCR with TURBT followed by neoadjuvant chemotherapy, the need for cystectomy to achieve cure in all patients has been questioned.

Researchers at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, NY initiated a phase 2 study in which 76 patients with MIBC received four cycles of neoadjuvant chemotherapy with gemcitabine, cisplatin, plus nivolumab immunotherapy after TURBT. The trial was associated with a clinical complete response (cCR) rate of 43% meaning that their tumors disappeared entirely and bladder-removal surgery was no longer necessary.

Thanks to a new drug combination some patients with bladder cancer might no longer need life-altering organ-removal surgery. The results of the study may help advance a more personalized approach to the management of MIBC.

Nat Med. Published online: 02 October 2023.
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.