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Related Experiment Videos

Advanced bladder and urothelial cancers.

D Raghavan1

  • 1University of Southern California, Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA 90033, USA.

European Journal of Cancer (Oxford, England : 1990)
|July 26, 2000
PubMed
Summary

Cytotoxic chemotherapy is evolving for advanced bladder cancer, with novel agents improving response rates. Validating new treatments in randomized trials is crucial to avoid bias from stage migration and case selection.

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Area of Science:

  • Oncology
  • Medical Oncology
  • Urologic Oncology

Background:

  • Cytotoxic chemotherapy has been a cornerstone in advanced bladder cancer management for over four decades.
  • Standard single-agent chemotherapy yields response rates of 15-25%, while combination regimens achieve 50-75% objective regression.

Purpose of the Study:

  • To review the evolving role of cytotoxic chemotherapy in advanced bladder cancer.
  • To highlight the incorporation of novel agents into combination regimens.
  • To emphasize the importance of rigorous clinical trial validation for new therapeutic strategies.

Main Methods:

  • Review of existing literature on chemotherapy for advanced bladder cancer.
  • Analysis of response rates for standard and novel chemotherapeutic agents.
  • Discussion of the impact of stage migration and case selection on outcome interpretation.

Main Results:

  • Novel agents like ifosfamide, taxanes, and gemcitabine show activity in advanced bladder cancer, both in previously treated and untreated patients.
  • Combination chemotherapy demonstrates higher objective regression rates compared to single-agent regimens.
  • Stage migration and case selection can create an artifact of improved outcomes, potentially masking true treatment efficacy.

Conclusions:

  • Novel chemotherapeutic agents are being integrated into combination regimens for advanced bladder cancer, showing promising activity.
  • Randomized clinical trials are essential to validate novel approaches and compare them against established standards.
  • Historical comparisons are unreliable due to biases from case selection, stage migration, and variations in follow-up and supportive care.

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