Treating Relapsed Muscle-Invasive Bladder Cancer

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There is not a clear standard of care with regard to second- and third-line treatments for patients with muscle-invasive bladder cancer in the United States, says Evan Y. Yu, MD. Clinical trials in Europe demonstrated a survival benefit with vinflunine, a type of taxane, which is available in in parts of Europe for this relapsed population. In the United States, taxanes and pemetrexed may be used in this setting, as recommended in the National Comprehensive Cancer Network guidelines.

Deciding which agent to use depends upon patient comorbidities, such as hepatic and renal function, and previous therapies, explain Yu and moderator Daniel P. Petrylak, MD. Results from an array of ongoing clinical trials should help to better define therapy in this population in the future.

Patients who relapse within 12 months of first-line, cisplatin-based therapy will generally have disease refractory to similar therapy again, Dean F. Bajorin, MD, notes. These individuals should not be re-treated with the same regimen in the relapsed setting, as they should be considered second-line candidates. In these situations, patients would be eligible for second-line therapy trials, Yu notes.

If the patient relapses within 6 months on frontline chemotherapy, Yu recommends a switch in drug classes. However, if relapse occurs past 12 months, Yu considers re-challenging the tumor with the original therapy. Those who relapse between 6 and 12 months are in a “hazy zone” in which an optimal decision is unclear.