Dr Nguyen on the Role of Concurrent Chemotherapy With TMT in MIBC

Anthony T. Nguyen, MD, PhD, faculty member, Department of Radiation Oncology, Cedars-Sinai Cancer Institute, discusses the role of concurrent chemotherapy with trimodal therapy (TMT) in patients with muscle-invasive bladder cancer (MIBC), as well as common chemotherapies utilized in this approach.

Treatment with TMT can be an effective way to preserve the bladder and improve long-term outcomes for patients with MIBC. Concurrent chemotherapy is a key element in the trimodal therapy approach for MIBC, serving as a radio-sensitizing agent to enhance the local efficacy of radiotherapy directed at the bladder and pelvis, Nguyen begins. Previously reported data have shown that adding chemotherapy to standard-of-care radiotherapy improves both local-regional control and invasive local-regional control, Nguyen reports. Moreover, chemotherapy has been found to reduce the 5-year rate of cystectomy without increasing the incidence of grade 3 or higher toxicities, he adds.

Based on these findings, concurrent chemoradiation has become the SOC for patients with MIBC treated with trimodal therapy, Nguyen continues. Although cisplatin is often the preferred choice of chemotherapy in North America, the National Comprehensive Cancer Network recommends several other radiosensitizing chemotherapy regimens, Nguyen says. For patients with impaired kidney function who are ineligible for cisplatin, which is common in bladder cancer cases, alternatives such as 5-fluororacil or Mitomycin C are often offered, Nguyen states. Additionally, single-agent gemcitabine is a preferred regimen and an alternative to cisplatin for concurrent chemoradiation in such cases, Nguyen notes.

These options provide flexibility in chemotherapy treatment selection, ensuring that patients receive effective radio-sensitization while considering individual factors such as renal function and tolerability, Nguyen concludes. The integration of concurrent chemotherapy with radiotherapy underscores the importance of a multimodal approach in optimizing treatment outcomes for muscle-invasive bladder cancer.