Flushing the bladder with a common chemotherapy drug after a cancerous tumour is surgically removed reduces the chances of that cancer returning.
Canadian and European clinical trials have proven this true and now a major U.S. study has done the same.
Dr. Edward Messing, an investigator with SWOG, the international clinical trials network funded by the National Cancer Institute, has found that an immediate infusion of the common chemotherapy agent gemcitabine after the removal of a bladder cancer tumour will significantly reduce the risk of cancer recurrence.
The Winfield W. Scott Professor and Chairman of Urology at the University of Rochester, Messing presented results of this Phase III, blinded clinical trial during an oral presentation at the annual meeting of the American Urological Association (AUA) held May 12-16 in Boston.
“This one extra step, using a drug that’s fairly inexpensive, has impressive results,” Messing said. “Urologists in Europe and Canada have been doing this procedure for more than 20 years with other chemotherapy drugs, with the research to prove it. Even the AUA recommends it. Now that we’ve got results from an American study, using a readily available drug that is very well-tolerated, maybe American urologists will start using gemcitabine this way. I certainly hope this finally changes our standard of care.”
Messing is former president of the Society of Urologic Oncology and, in 2013, was awarded the prestigious Presidential Citation from the AUA for his work as a bladder cancer researcher and educator.
Messing led a SWOG team that conducted the trial, S0337, which enrolled 406 eligible patients with non-muscle invading bladder cancer.
Bladder cancer is the sixth most commonly diagnosed cancer in the United States, and the third most common among men.
The low grade, non-muscle invasive form of the disease is common, making up about half of all newly diagnosed cases.
Treatment includes a procedure called transurethral resection for bladder tumour, or TURBT, which involves a surgeon removing cancerous tissue from the bladder.
In the Messing study, patients were randomised into two groups.
One group, after TURBT, received a single 3.5-ounce instillation of gemcitabine, which was administered directly after surgery and allowed to sit in the bladder for one hour.
The drug kills cancer cells, and is often used to treat advanced bladder cancer in combination with the chemotherapy drug cisplatin.
The other group of patients, after TURBT, received an infusion of saline only.
Both groups were followed for four years.
Results were strong and clear: There was a significant 34 percent reduction in risk of recurrence for patients receiving the gemcitabine infusion.
While more of those patients experienced moderate post-surgical pain, investigators found, they experienced no other additional side effects, such as bleeding, compared with the patients who received a saline infusion alone.
“The big deal here is that cancer recurrence is common for people diagnosed with this less aggressive form of bladder cancer,” Messing said. “I know some patients who undergo four TURBT procedures a year. If we can cut down on these recurrences, we will save a lot of people a lot of pain, money, and time lost to recovery.”