Adding chemotherapy before surgery nearly doubles average survival time to more than six years for some patients with bladder cancer, a study released on Monday showed.
Dr. Ronald Natale, the study's lead author, said the findings need to be confirmed in another trial before chemotherapy becomes standard practice prior to surgical removal of patients' bladders.
But Natale, acting director of Cedars-Sinai Comprehensive Cancer Center in Los Angeles, said the results were so impressive that physicians should discuss the option with cancer patients facing bladder removal.
"The striking results of this study require that patients should at least be informed that pre-operative chemotherapy might significantly change their survival," Natale said.
His findings were released at the annual meeting of the American Society of Clinical Oncology, a gathering of more than 25,000 cancer specialists.
Giving drugs to shrink tumors before surgery is used in other cancers.
About 54,000 Americans are diagnosed with bladder cancer annually, and about 12,500 die each year. In about 18,000 patients, the cancer appears to be confined to the bladder and is not detectable elsewhere in the body.
Standard treatment in those cases is bladder removal to prevent the cancer from spreading. In more than half of patients, the cancer has spread but cannot be detected. It later grows and can be deadly.
In a 14-year study begun in 1987, researchers tested whether using a standard combination of four chemotherapy drugs before surgery would extend survival. The scientists' theory was that the chemotherapy would kill any microscopic cancer sites throughout the body.
They found that average survival time was 3-1/2 years for patients who only had surgery, and a little more than six years for people who received the chemotherapy-surgery combination. The study included 317 patients.
The findings also suggest that chemotherapy alone may be sufficient in some patients, allowing them to keep their bladders, Natale said. Researchers found that 38 percent of bladders that were removed had no evidence of cancer.
The chemotherapy could be tough on patients, Natale said. Side effects included hair loss, mouth sores, stomach upset and drops in blood cell counts. Natale said newer drugs might produce the same benefit with less toxic effects.
The chemotherapy drugs used in the study were methotrexate, vinblastine, doxorubicin and cisplatin.