PracticeUpdate: Haematology & Oncology

EUROPEAN SOCIETY OF MEDICAL ONCOLOGY 2016 CONGRESS 26

Dr Arlene Siefker-Radtke discusses current concepts inmanaging rare histologies in bladder cancer Sumanta Pal

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

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.

© ESMO 2016

PRACTICEUPDATE HAEMATOLOGY & ONCOLOGY