B174
Chemotherapy for bladder cancer: a United Kingdom practice survey
Patricia Roxburgh, Balaji Venugopal, Rob Jones
The Beatson West of Scotland Cancer Centre, Glasgow, UK
Background
Chemotherapy has an established role in treatment of locally advanced (LABC) and metastatic bladder cancer (MBC). Chemotherapy regimens vary, in particular, there is no agreed standard for second line treatment. To aid future study design, we conducted a current practice survey.
Method
A written questionnaire was mailed to 110 UK urological oncologists requesting anonymous replies.
Results
Of 61 questionnaires returned, 8 denied treating bladder cancer.
In first line MBC, 45/53 [85%] preferred gemcitabine/cisplatin (GC), with varying schedules, followed by methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) (7/53[13%]). In patients unsuitable for cisplatin, 39/51 [76%] used gemcitabine/carboplatin (GCarbo). Other options were gemcitabine alone (5/51[10%]) and methotrexate/carboplatin/vinblastine (CMV) (2/51[4%]).
In second line, 10/43 [23%] used GC, 7/43 [16%] GCarbo, 6/43 [14%] paclitaxel/carboplatin (PC) and 6/43 [14%] MVAC. Given no formulary restrictions, 16/34 [47%] clinicians would choose paclitaxel alone or combined with platinum as second line regimen. 25/26 [96%] clinicians reported 3 weekly PC as an acceptable control arm for a randomised controlled trial of second line chemotherapy.
In neoadjuvant setting
42/49 [86%] used GC and 4/49 [8%] used MVAC based regimens.
In adjuvant setting,
29/34 [85%] clinicians chose GC and the remainder CMV or MVAC.
Conclusion
In UK clinical practice, chemotherapy for bladder cancer is largely uniform. Standard of care for neoadjuvant, adjuvant and first line for MBC is gemcitabine/platinum doublet. Second line treatment of MBC is variable and this needs further clinical study. These data will inform design of future trials in MBC treatment.
