What are the benefits to adjuvant chemotherapy in the treatment of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Although the evidence supporting adjuvant chemotherapy is less compelling than that for neoadjuvant chemotherapy, some patients may benefıt from adjuvant chemotherapy, such as those who underwent up-front radical cystectomy and have extensive tumor invasion of the bladder wall or lymph node involvement. [70]

The AUA guidelines recommend offering adjuvant cisplatin-based chemotherapy to patients with non–organ-confined (pT3/T4 and/or N+) disease at cystectomy who are eligible for, but have not received, cisplatin-based neoadjuvant chemotherapy. [80]

A phase III trial in 284 patients with pT3 to T4 or node-positive bladder cancer found insignificant improvement in overall survival with adjuvant cisplatin-based chemotherapy given within 90 days after cystectomy, compared with deferral of chemotherapy until relapse: after a median follow-up of 7 years, 66 of 141 patients (47%%) in the immediate chemotherapy arm had died, compared with 82 out of 143 (57%) in the deferred chemotherapy arm (P=0.13). However, patients who received iimmediate adjuvant chemotherapy had significantly longer progression-free survival (PFS): 5-year PFS was 47.6% in the immediate chemotherapy arm versus 31.8% in the deferred treatment arm (P< 0.0001). [127]

This study did not meet its accrual goal of 644 patients and was terminated early. Nevertheless, it remains the largest randomized trial of adjuvant chemotherapy to date. [70]


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