Examining the management of muscle-invasive bladder cancer by medical oncologists in the United States

详细信息    查看全文

• 作者：Andrea B. Apolo ; M.D.^a ; ^{andrea.apolo@nih.gov" class="auth_mail} ; ^{andrea.apolo@gmail.com" class="auth_mail} ; Joseph W. Kim ; M.D.^b ; Bernard H. Bochner ; M.D.^c ; Seth M. Steinberg ; Ph.D.^d ; Dean F. Bajorin ; M.D.^e ; Wm. Kevin Kelly ; D.O.^f ; Piyush K. Agarwal ; M.D.^g ; Theresa M. Koppie ; M.D.^h ; Matthew G. Kaag ; M.D.ⁱ ; David I. Quinn ; M.B.B.S. ; Ph.D.^j ; Nicholas J. Vogelzang ; M.D.^k ; ^l ; Srikala S. Sridhar ; M.D.^m
• 关键词：Adjuvant chemotherapy ; Medical oncologist ; Muscle-invasive bladder cancer ; Neoadjuvant chemotherapy ; Survey
• 刊名：Urologic Oncology: Seminars and Original Investigations
• 出版年：July 2014
• 年：2014
• 卷：32
• 期：5
• 页码：637-644
• 全文大小：1105 K

文摘

Neoadjuvant chemotherapy (NACT) for the treatment of muscle-invasive bladder cancer (MIBC) remains underutilized in the United States despite evidence supporting its use.

Objectives

To examine the perioperative chemotherapy management of patients with MIBC by medical oncologists (MedOncs) to move toward standardization of practice

Participants and methods

A 26-question survey was emailed to 92 MedOncs belonging to the Bladder Cancer Advocacy Network or the American Society of Clinical Oncology for completion from May to October 2011

Results

A total of 83 MedOncs completed the survey: 52% were based in academic centers. Most referrals were from urologists (79%). NACT for treatment of MIBC and high-grade upper-tract urothelial carcinoma is offered by 80% and 46% of respondents, respectively. Adjuvant chemotherapy for treatment of MIBC and upper-tract urothelial carcinoma is offered by 46% and 42% of respondents, respectively. NACT was not offered by 49%, 29%, and 35% of respondents if Eastern Cooperative Oncology Group performance status was 3 or greater, if patients had T2 lesions without lymphovascular invasion, and if the glomerular filtration rate was<50 ml/min, respectively. Chemotherapy regimens included gemcitabine/cisplatin (90%), methotrexate/vinblastine/adriamycin/cisplatin (30%), dose-dense methotrexate, vinblastine, adriamycin, and cisplatin (20%), and gemcitabine/carboplatin (37%).

Conclusions

Most MedOncs (79%) in this survey offer perioperative chemotherapy to all patients with MIBC. This increased use of NACT is higher than previously reported, suggesting an increase in the adoption of recommendations that follow best evidence.