Dr Garje on the Benefits of Multimodal Treatment in Small Cell Bladder Cancer

Rohan Garje, MD, chief, of Genitourinary Medical Oncology, Baptist Health Miami Cancer Institute, discusses the benefits of a multimodal approach for the treatment of patients with small cell bladder cancer.

Garje and colleagues presented results from a national study at the 2024 ASCO Annual Meeting exploring the impact of different treatment modalities on the survival outcomes of patients with small cell bladder cancer using data from a nationwide registry. The retrospective study included patients with locoregional small cell bladder cancer (T1-T4, N0-N3, M0).

Garje explains that patients who received the perioperative chemotherapy in either the neoadjuvant or adjuvant setting in combination with definitive cystectomy or partial cystectomy, had better survival outcomes compared with other treatment modalities. Patients treated with perioperative systemic therapy with definitive surgery experienced a median overall survival (OS) of 64.49 months. Patients given perioperative systemic therapy plus concurrent chemoradiation had a median OS of 29.27 months. Those who had surgery alone experienced a median OS of 14.13 months. The median OS was 21.29 months for those given systemic therapy alone, and the median OS was 7.82 months for patients given radiotherapy alone.

Notably, perioperative systemic therapy in combination with surgery was associated with a 54% reduction in the risk of death compared with surgery alone (HR, 0.46; 95% CI, 0.37-0.58). Systemic therapy plus concurrent chemoradiation was linked to a 41% reduction in the risk of death vs surgery alone (HR, 0.59; 95% CI, 0.47-0.73).

These results showed patients receiving single-modality therapies—such as surgery, radiation therapy, or systemic therapy—were associated with lower survival , Garje notes. For clinicians treating patients with small cell bladder carcinoma, Garje emphasizes the most positive outcomes that have been observed in this database was from patients who received chemotherapy along with definitive surgery.

Moreover, further research and clinical trials are essential to continue refining and enhancing multimodal treatment strategies for this patient population, Garje concludes.