CHEMOTHERAPY before surgery nearly doubles bladder cancer survival

Tuesday, May 15th 2001, 12:00 am

By: News On 6

SAN FRANCISCO (AP) _ The typical survival of victims of early but advancing bladder cancer nearly doubles to six years when doctors treat them first with chemotherapy rather than relying solely on surgery, as is now standard, a study concludes.

The research, released Monday, is the latest to support the trend of shrinking cancer with drugs before attempting to remove it. The strategy is now sometimes attempted for a variety of tumors, including breast, colon and esophageal cancer, though the improvement in survival ordinarily amounts to a few months.

``It's very unusual to be measuring a survival advantage in terms of years. We've been hitting singles and doubles. This is a home run,'' said Dr. Charles Balch, executive vice president of the American Society of Clinical Oncology.

The latest findings were presented in San Francisco at the society's annual meeting by Dr. Ronald Natale of Cedars-Sinai Medical Center in Los Angeles, who directed the 14-year study.

An estimated 54,000 Americans are diagnosed with bladder cancer annually, and 12,500 die from the disease.

The study was conducted on people with what doctors call locally advanced disease _ cancer that had grown into the muscular wall of the bladder but has not clearly spread beyond.

Nevertheless, even though the tumor cannot be seen outside the bladder, microscopic bits of cancer often have already escaped. An estimated 18,000 to 20,000 cases are discovered at this stage each year.

Typically, surgeons remove the bladder, but chemotherapy is avoided unless the cancer clearly invades other organs later.

In the latest study, 306 patients were treated with surgery alone or with chemotherapy followed by surgery. Median survival of the chemotherapy patients was just over six years, compared with about 3 1/2 years for those getting surgery alone.

Natale said the study raises the possibility that some patients might be treated with chemotherapy without removal of the bladder at all. When surgeons took out the patients' bladders in this study, they found that in 38 percent of the chemotherapy patients, the drugs appeared to have wiped out the cancer entirely. Eighty-five percent of these patients were still alive five years later.

He said doctors might be able to use biopsies to check for the presence of lingering tumor after treatment and then decide whether it is necessary to take out the bladder.

Just how doctors will use the latest results is uncertain, since they challenge long-established practice. Natale said he thinks pre-surgical chemotherapy should at least be offered as an alternative to patients, though some physicians may be skeptical.

``It's a tough four-drug combination for patients,'' he said. ``This positive outcome will stimulate a very vigorous debate.''

The drugs used were methotrexate, vinblastine, doxorubicin and cisplatin. More than a quarter of patients suffered significant side effects, including diarrhea, nausea, mouth sores or constipation. Depression of white blood cells was also common.

This combination has been standard treatment since the 1980s for advanced spreading bladder cancer. Natale said a newer combination of cisplatin and gemcitabine, which has fewer side effects, might work as well but has not been tested for use before surgery.

Natale said doctors might also be skeptical of the findings because seven prior studies, most of them small and involving single chemotherapy drugs, failed to show an advantage to pre-surgical treatment.