Dr. Desai on Expanding Options for Cisplatin-Ineligible Bladder Cancer

Neil Desai, MD, associate professor, radiation oncology, UT Southwestern Harold C. Simmons Comprehensive Cancer Center, discusses the variety of options available for patients with localized urothelial cancer who are ineligible for cisplatin-based chemoradiation.

Although cisplatin-based chemoradiation therapies such as those studied in the RTOG trials have been proven effective in many patients with urothelial cancer who are considering bladder preservation, they are not an option for elderly patients, patients with comorbidities such as renal issues, or those who are cisplatin ineligible for other reasons, Desai explains. Instead, regimens such as 5-FU and mitomycin C, which are highly effective in the cisplatin-ineligible population, can be used, Desai notes. Gemcitabine plus radiation administered in shorter-course and longer-course radiation schedules is also effective and feasible to use in patients who may not be eligible for other therapies, Desai adds.

The majority of patients with localized bladder cancer are eligible for some form of radiosensitizing chemotherapy, Desai says. In the future, immunotherapy will play an increasingly larger role in urothelial disease, such as in the adjuvant setting with the goal of bladder preservation, Desai concludes.