Dr Nguyen on the Role of Concurrent Chemotherapy With TMT in MIBC

Anthony T. Nguyen, MD, PhD, faculty member, Department of Radiation Oncology, Cedars-Sinai Cancer Institute, discusses the role of concurrent chemotherapy with trimodal therapy (TMT) in patients with muscle-invasive bladder cancer (MIBC), as well as common chemotherapies utilized in this approach.

Treatment with TMT can be an effective way to preserve the bladder and improve long-term outcomes for patients with MIBC. Concurrent chemotherapy is a key element in the trimodal therapy approach for MIBC, serving as a radio-sensitizing agent to enhance the local efficacy of radiotherapy directed at the bladder and pelvis, Nguyen begins. Previously reported data have shown that adding chemotherapy to standard-of-care radiotherapy improves both local-regional control and invasive local-regional control, Nguyen reports. Moreover, chemotherapy has been found to reduce the 5-year rate of cystectomy without increasing the incidence of grade 3 or higher toxicities, he adds.

Based on these findings, concurrent chemoradiation has become the SOC for patients with MIBC treated with trimodal therapy, Nguyen continues. Although cisplatin is often the preferred choice of chemotherapy in North America, the National Comprehensive Cancer Network recommends several other radiosensitizing chemotherapy regimens, Nguyen says. For patients with impaired kidney function who are ineligible for cisplatin, which is common in bladder cancer cases, alternatives such as 5-fluororacil or Mitomycin C are often offered, Nguyen states. Additionally, single-agent gemcitabine is a preferred regimen and an alternative to cisplatin for concurrent chemoradiation in such cases, Nguyen notes.

These options provide flexibility in chemotherapy treatment selection, ensuring that patients receive effective radio-sensitization while considering individual factors such as renal function and tolerability, Nguyen concludes. The integration of concurrent chemotherapy with radiotherapy underscores the importance of a multimodal approach in optimizing treatment outcomes for muscle-invasive bladder cancer.

Videos

Anthony T. Nguyen, MD, PhD, discusses the role of concurrent chemotherapy with trimodal therapy in patients with muscle-invasive bladder cancer.

Dr Nguyen on the Use of Trimodal Therapy in MIBC

Anthony T. Nguyen, MD, PhD, faculty member, Department of Radiation Oncology, Cedars-Sinai Cancer Institute, discusses the methodology of trimodal therapy (TMT) in patients with muscle-invasive bladder cancer (MIBC), as well as disease characteristics that may qualify patients for bladder-preserving treatment.

TMT is an effective treatment approach for patients with MIBC, as it aims to preserve the native bladder and optimize long-term patient outcomes, Nguyen says. The administration of TMT is inherently multidisciplinary, requiring collaboration between urologists, medical oncologists, and radiation oncologists, Nguyen notes. In patients with MIBC, TMT involves the transurethral resection of bladder tumor, which is a maximal endoscopic resection, followed by concurrent chemoradiation targeting both the pelvic lymph nodes and the bladder, Nguyen explains.

This comprehensive treatment approach extends beyond the active phase with a structured follow-up regimen recommended by the National Comprehensive Cancer Network (NCCN), according to Nguyen. Follow-up consists of cystoscopies; imaging with PET-CT scans, CT scans, or MRIs; and urine and blood tests to monitor for potential cancer recurrence, Nguyen emphasizes. Although radical cystectomy remains a standard treatment approach for patients with MIBC, TMT is widely considered an effective alternative and has received a category 1 recommendation from the NCCN for use in eligible patients, Nguyen adds.

Determining the ideal candidates for bladder-preserving treatments involves a multidisciplinary approach, Nguyen explains. Regarding overall tumor burden within the bladder, patients would ideally have a solitary T2 or T3a tumor measuring less than 6 centimeters. Moreover, the presence of tumor-associated hydronephrosis often correlates with tumor burden and may impact the likelihood of patients achieving a complete response with TMT, although this is not a definite contraindication to bladder preservation, Nguyen notes. Achieving visibly complete endoscopic tumor resection is an essential goal of bladder-preserving treatment, although some randomized clinical trials have demonstrated favorable disease-free survival rates upwards of approximately 80% with a biopsy-only approach, Nguyen concludes.

Anthony T. Nguyen, MD, PhD, discusses the methodology of trimodal therapy in patients with muscle-invasive bladder cancer.

Anthony T. Nguyen, MD, PhD

Articles

Dr Nguyen on the Role of Concurrent Chemotherapy With TMT in MIBC

Dr Nguyen on Trimodal Therapy in MIBC