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Radiotherapy plus chemotherapy better than radiotherapy alone for bladder cancer patients

By Clinical Pharmacist

Addition of chemotherapy to radiotherapy for the treatment of bladder cancer improves disease-free survival compared with radiotherapy alone, suggests research published online in the New England Journal of Medicine (19 April 2012).   

Radiotherapy is currently used as an alternative to cystectomy for patients with muscle-invasive bladder cancer, according to Kingsley Wildman, Macmillan pharmacist at Sussex Cancer Network. “This study has the potential to change the management of these patients,” he commented.

In this unblinded study, researchers randomised 360 patients with muscle-invasive bladder cancer to receive radiotherapy with or without fluorouracil and mitomycin.

Two-year, disease-free survival was better for patients receiving chemotherapy and radiotherapy than for those who received radiotherapy alone (67% versus 54%; hazard ratio 0.68, 95% confidence interval 0.48–0.96; P=0.03).     

There was no significant difference in the rate of grade 3 or 4 adverse events during treatment or follow-up.

“What is remarkable, especially in this day and age, is the use of well known and inexpensive chemotherapy drugs to deliver the improvements,” Mr Wildman told Clinical Pharmacist.  

He said that the use of chemotherapy with radiotherapy would result in additional pressure on capacity of some oncology units, but that this would likely be small and manageable. He also suggested that the additional prescribing costs would be minimal.

“Pharmacy teams should actively collaborate with their radiotherapy and oncologist colleagues to set up a co-ordinated treatment plan for patients in whom chemotherapy will be given at the same time as radiotherapy,” Mr Wildman advised.

Citation: Clinical Pharmacist URI: 11100554

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