Dr Garje on Unmet Needs in Small Cell Bladder Cancer

“Most of the data that we use for the treatment of [patients with] small cell carcinoma arising from any part of the body, other than lung, is extrapolated from small cell lung cancer, so there are limited clinical trials and prospective studies [in this setting]. [Therefore,] it is important for us to use retrospective data from large databases to see how patients fare [with various] treatment choices and see if that can improve their outcomes.”

Rohan Garje, MD, chief, Genitourinary Medical Oncology, Baptist Health Miami Cancer Institute, discusses the unmet needs for patients with small cell bladder cancer and the rationale for investigating the effect of different treatment modalities on survival outcomes in patients with locoregional disease.

Small cell bladder carcinoma is a rare and aggressive malignancy with limited treatment data, and most therapeutic approaches in small cell carcinomas broadly are extrapolated from small cell lung cancer due to the paucity of dedicated clinical trials or prospective studies in other tumor types, Garje begins. This lack of direct evidence presents challenges for oncologists in determining optimal treatment strategies for this patient population, he states. Real-world data and large retrospective analyses are thus critical in understanding treatment outcomes and guiding management in this patient population, Garje emphasizes.

Accordingly, Garje and colleagues conducted a retrospective national study evaluating the effects of various treatment modalities on survival outcomes in patients with locoregional small cell bladder carcinoma (T1-T4, N0-N3, M0). The study used data from a nationwide registry and analyzed outcomes based on different therapeutic approaches. Results presented at the 2024 ASCO Annual Meeting demonstrated that patients who received perioperative chemotherapy, either in the neoadjuvant or adjuvant setting, combined with definitive cystectomy or partial cystectomy, had improved survival outcomes compared with patients treated with other modalities. These findings underscore the importance of incorporating perioperative chemotherapy with surgical intervention in the management of locoregional small cell bladder carcinoma, Garje concludes.