Predicting the Return of Bladder Cancer

Bladder cancer recurrence may be predicted with panel of five biomarkers

(RxWiki News) Here’s the scenario: someone has bladder cancer, and the bladder is removed as part of the treatment. So, can bladder cancer return, even though the organ is no longer there? What do you think?

The answer, unfortunately is “yes,” bladder cancer can return after the bladder is removed. In fact, the disease comes back in one out of every three patients.

A new study tried to predict which patients may be at higher risk of recurrence (return).

These researchers found that patients with changes in various molecules were more likely to see their cancers recur.

Being able to identify these patients may help clinicians determine who could benefit from chemotherapy after surgery to keep the disease from returning, the authors reported.

"Ask about receiving chemotherapy before or after surgery."

Yair Lotan, MD, professor of urology at University of Texas Southwestern and the study’s primary investigator, and colleagues followed 216 bladder cancer patients to see if their cancers returned.

The patients had muscle invasive bladder cancer, meaning the cancer had reached the muscles around the bladder.

Standard of care for invasive bladder cancer involves removing all or part of bladder. Chemotherapy may be given before surgery, but is rarely given after surgery, according to the authors.

The researchers tested tissues removed from the patients for five different molecular markers.

After controlling for variables relating to tumor characteristics and treatment variables including previous chemotherapy, the researchers found that the number of altered molecules was able to predict cancer return and mortality.

DailyRx News spoke to Alexander Kutikov, MD, associate professor of urologic surgical oncology at Fox Chase Cancer Center in Philadelphia, PA, about this study, which he said was important but also highlighted challenges in bladder cancer research.

“Risk-stratifying [grouping people according to risk] patients following surgery for receipt of additional chemotherapy potentially minimizes overtreatment of patients who are destined to remain disease-free. The investigators showed that although biomarkers which were available to them were able to show a statistically significant improvement in accuracy of prediction over standard approaches, the improvement was rather modest (3 percent),” Dr. Kutikov explained.

“Furthermore overall ability to predict which patients were going to recur/progress after surgery remained less than perfect (83 percent). As such, receipt of chemotherapy prior to surgery (neoadjuvant chemotherapy), remains the most robust evidence-based strategy in improving survival of patients with muscle-invasive bladder cancer, since pre-operative under-staging is extremely common and delivery of chemotherapy to patients who need it most following surgery remains extremely challenging, as many individuals are often too debilitated to receive cytotoxic agents in a timely manner following surgical intervention," Dr. Kutikov said.

Findings from this study were published in the most recent edition of European Urology.

The Simmons Cancer Center provided funding for this study and was involved in data collection. No conflicts of interest were reported.

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Review Date: 
May 7, 2013