New Bladder-preserving Therapy Promising in Bladder Cancer

A new bladder-preserving approach to treatment of locally invasive bladder cancer appears promising, both for patients for whom radical cystectomy is indicated and for those previously ineligible for curative treatment. These findings were recently published in the International Journal of Oncology

The bladder is a hollow organ located in the pelvis. Its primary function is to store urine. The bladder has a muscular wall that allows it to get larger and smaller as urine is stored or emptied. Bladder cancer is diagnosed in roughly 50,000 men and 17,000 women annually in the United States.

Patients whose cancer has spread to deeper tissues in the bladder may be treated with a radical cystectomy, which is the surgical removal of the bladder and some nearby organs. Not all patients, however, are candidates for radical cystectomy. Alternative curative procedures for such patients are therefore needed, as are curative options that preserve the bladder.

Balloon-occluded arterial infusion (BOAI) with hemodialysis delivers a high concentration of chemotherapy (cisplatin/ Gemzar® [gemcitabine]) to the site of the tumor. By delivering anticancer agents only to the site of the tumor, other parts of the body are not adversely affected by the chemotherapy.

The current study evaluated the combination of BOAI and hemodialysis with concurrent radiation therapy. The researchers involved with the study refer to this as the “OMC” (Osaka Medical College) regimen. An important difference between the OMC regimen and radical cystectomy is that the OMC regimen does not involve removal of the bladder.

The study enrolled 192 patients with Stage T2, T3, or T4 muscle-invasive bladder cancer that had not spread to distant sites in the body. Half the patients were assigned to receive the OMC regimen, and half underwent radical cystectomy. Patients in the OMC regimen group who did not experience a complete response (CR) underwent cycstectomy or a second course of BOAI with a higher dose of chemotherapy.

  • More than 89% of patients with locally invasive tumors (T2 or T3 node-negative) on the OMC regimen experienced a CR. All but one of these 69 patients were alive with no evidence of recurrence at a median follow-up of 161 weeks. Complete responses were less common among patients with T4 or node-positive disease.
  • The five-year overall survival rate for the OMC regimen was 91.5% versus 59.8% for cystectomy.
  • The 15-year overall survival rate for the OMC regimen was 81.3% versus 40.1% for cystectomy.
  • Side effects associated with the OMC regimen were moderate.

The researchers conclude that the OMC regimen may provide a potentially curative, bladder-preserving treatment option for patients with locally invasive bladder cancer.

This regimen may be an option not only for people who would otherwise undergo radical cystectomy but also for people who are unable to tolerate radical cystectomy or conventional chemotherapy as a result of age or health problems.

Reference: Azuma H, Inamoto T, Ibuki N, et al. Novel bladder preservation therapy for locally invasive bladder cancer: Combined therapy using balloon-occluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation. International Journal of Oncology. Doi: 10.3892/ijo_00000727