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Dr Arlene Siefker-Radtke discusses
current concepts inmanaging rare
histologies in bladder cancer
Sumanta Pal
MD speaks with
Siefker-Radtke
MD (left), on a
variety of rare
bladder cancer
histologies and
their management. Dr Siefker-
Radtke is Associate Professor,
Department of Genitourinary
Medical Oncology, Division of
Cancer Medicine, the University
of Texas MD Anderson Cancer
Center, and Clinical Co-Leader
of Bladder SPORE Executive
Committee in Houston, Texas.
Dr Pal:
Something that I always call upon
you for is how to manage rare histologies of
bladder cancer. I think many of us around
the country acknowledge you as being the
foremost expert in that area. We were having
a little dialogue earlier about an abstract
that touches on small-cell carcinoma of the
bladder. Can you tell us a little bit more about
the data that’s been presented here and some
of the caveats?
Dr Siefker-Radtke:
This was a retrospective
trial in small-cell urothelial cancer, so it’s
actually retrospective data. I don’t believe
patients signed prospective consent. And they
are correct, it is one of the largest groups of
small-cell patients that were presented, but
the population of patients that were actually
treated with neoadjuvant chemotherapy is
actually relatively low. There’s been other
institutions, like MD Anderson, where
we’ve published more patients receiving
neoadjuvant aggressive chemotherapy.
In the small-cell abstract at this meeting,
there was a suggestion that there’s no
benefit from either neoadjuvant or adjuvant
chemotherapy for small-cell tumours of the
bladder. Now that’s different from what
we’ve previously published, where we found
that giving an aggressive chemotherapy
regimen, and the majority of our patients,
probably over 80%, received a combination of
ifosfamide Adriamycin, which we alternated
with etoposide cisplatin. And what we saw
retrospectively was that giving this aggressive
treatment resulted in a statistically significant
improvement in survival compared to patients
who underwent surgery first, regardless of
whether they received adjuvant treatments.
In the abstract here at ESMO, when you look
at the group of patients who actually received
chemotherapy, it was 24 patients receiving
neoadjuvant treatment. I think our group
was over 50 patients, and of the neoadjuvant
patients, only half of those, so approximately
12, received a cisplatin-based regimen like
etoposide cisplatin, the other half received
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