Which is Best Chemotherapy Option for Advanced Bladder Cancer?

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Transitional cell or urothelial carcinoma is the most common type of bladder cancer, accounting for more than 90% all bladder cancers.  This type of cancer is sensitive to treatment with chemotherapeutic agents.  

This type of cancer is usually treated with cisplatin-based chemotherapies such as methotreaxate, vinblastine, doxorubicin, and cisplatin (MVAC) and gemcitabine plus cisplatin.  Based on clinical trial results, 50%-60% of patients treated these agents can achieve objective responses and 10%-20% can achieve complete responses. 

However, not all patients can receive cisplatin-based chemotherapy.  For patients who have impaired renal function and other co-morbidities, carboplatin-based regimens are frequently utilized. 

Since there was no comparison on the effectiveness of the two regimens (cisplatin- versus carboplatin-based chemotherapy), an analysis was carried out. 

In the analysis, a total of 286 patients with metastatic UC from four randomized trials were included and their responses to the therapeutic treatments were analyzed.  

The investigators found that cisplatin-based chemotherapy was associated with a significantly higher likelihood of achieving a complete responses and overall responses (2.54 times and 34% higher in achieving complete and overall responses respectively) than carboplatin-based chemotherapy.  

This analysis concluded that cisplatin-based chemotherapy is superior to carboplatin-based, chemotherapy in achieving overall and complete responses in patients with metastatic urothelial cancers. 

Definition:

Complete response was defined as the disappearance of all signs of cancer in response to treatment.   

Partial response was defined as a decrease in the size of a tumor, or in the extent of cancer in the body, in response to treatment.  

Overall response = complete response + partial response. 

Source: Annals of Advance Oncology, May 4, 2011. 

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