The National Bladder Cancer Group's experience: invasive and metastatic bladder cancer selected reports

The National Bladder Cancer Group, a multidisciplinary organization that was originally the therapeutic arm of the National Bladder Cancer Project, reported the results of trials using cisplatin with and without cyclophosphamide in patients with advanced bladder cancer. The objective response rate in both arms was 16% of 109 patients with no difference between the arms. Other studies included cisplatin and irradiation for patients who had comorbid conditions that prevented cystectomy (local response--cT2 11/13 patients; cT3 & cT4 2/4 patients). Seventy patients were treated on the same protocol, and 33 were alive 4 years later. Complete response versus local failure produced 57% versus 11% at 4 years. After cessation of funding, the clinicians at the Massachusetts General Hospital agreed to follow a potentially bladder-sparing multimodality protocol, which stipulated that visible tumor be resected following which the patient received methotrexate, vinblastine and cisplatin (MCV), small-volume irradiation, and more cisplatin with midcourse cystectomy if local tumor persisted. Overall survival was 45%. The Radiation Therapy Oncology Group conducted a similar study omitting MCV from one arm. The 5-year survival rate was 38% with no advantage for either arm.