ASCO GU 2017: BC2001 long-term outcomes: A phase III randomized trial of chemoradiotherapy versus radiotherapy (RT) alone and standard RT versus reduced high-dose volume RT in muscle-invasive bladder cancer

Orlando, Florida USA (UroToday.com) This year’s genitourinary cancer symposium allowed for Emma Hall to present long-term results from BC20001. Given that BC2001 showed that that reduced high dose volume RT rather than standard RT did not significantly reduce late side effects at limited follow up, the long term results have been anticipated [Huddart 2013]. Unfortunately, in this 10-year follow up data, due to difficulty with accrual, the power samples were recalculated for a smaller size that was then able achieve its final accrual. 458 ended up being able to be included with 118 months follow up.

The updated data demonstrates that locoregional control was improved with chemoradiotherapy compared to radiation therapy along, and when known prognostic factors were considered there was an improvement in DSS. Despite trends in improvement, no statistical difference was seen in overall survival, bladder cancer specific survival or metastasis free survival. However, Salvage cystectomy rate was lower for chemoradiation (11%) compared to radiation alone (17%) (P=0.003). There were no differences between standard radiation therapy and high dose volume radiation therapy at any endpoint.

Although the authors could not conclude on dose volume, the authors conclude that chemo-radiation therapy with 5FU/MMC should be standard of care offering an alternative to other cisplatin containing regimens in patients undergoing chemo-radiation. And, although these results are promising, caution should be given to this statement without a head to head comparison of survival to patients who underwent gold standard therapy of Neoadjuvant Chemotherapy and Radical cystectomy with lymph node dissection. Clinical trial information: ISRCTN68324339.

First Author: Emma Hall

Written By: Michael J Metcalfe, MD, Fellow of Urologic Oncology Urology, MD Anderson Cancer Center, Houston TX
Ashish M. Kamat, MD, MBBS, FACS, President, International Bladder Cancer Network Chair, Society of Immunotherapy for Cancer (SITC), BCTF, Director of Urologic Oncology Fellowship, Professor of Urology, Attending Surgeon, Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston TX

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA

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