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Actos Lawsuit: For invasive urothelial carcinoma, most of the information from clinical trials has been obtained from patients who were initially given chemotherapy by intravenous injection and who then went on to cystectomy or to definitive radiotherapy. Most of the reported trials indicate that the use of single chemotherapy drugs does not have an extensive beneficial effect, but that the use of combinations of three or four chemotherapy drugs can shrink the bladder cancer in about 70 percent of cases. The drugs can also improve the cure rate and length of survival. For you as a patient, the information gleaned from these clinical trials means that if you have urothelial cancer, your doctors are likely to recommend treatment that includes a cocktail of several carefully targeted chemotherapy drugs as well as cystectomy or radiotherapy.
With some cancers, such as breast cancer, it is fairly standard practice to give several doses of chemotherapy after surgery, especially for tumors with high-risk pathological features, such as lymph-node involvement. We know of six studies that have examined the question of when chemotherapy should be administered for best outcome with bladder cancer, but the results are somewhat inconclusive about whether chemotherapy is most effective if given before or after surgery.
A large randomized trial is in progress in Europe to study whether intravenous chemotherapy after cystectomy improves the cure rate. Until the results of that study are available, most medical teams recommend consideration of first-line chemotherapy, followed by cystectomy, for deeply invasive bladder cancer. Sometimes a cystectomy reveals a cancer that is deeper or more extensive than had been expected; in that situation, the urologist or oncologist will usually discuss the benefits and drawbacks of using chemotherapy after surgery (called adjuvant chemotherapy), typically with the same drugs that would have been given before surgery.
Following are descriptions of some common chemotherapy combinations. This is not an exhaustive list. Talk with your doctor about your treatment plan. Remember that not all people experience all side effects. Your general health, age, other drugs you might be taking, and the dosage of the chemotherapy drugs may affect what side effects you experience. Many side effects are unpleasant, but they are temporary, and the severity of effects is variable. Some side effects are more serious, and you should talk with your medical team about them.
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Radiation uses radioactive beams or pellets to kill cancer cells. Your medical team may recommend a course of radiation therapy in addition to chemotherapy and/or surgery. Radiation therapy for bladder cancer is commonly delivered with a machine that focuses an invisible external beam on die area that requires treatment. The procedure is painless and similar to having an ordinary X-ray done. In the usual approach, your doctors will use your CT scan as a road map of your abdomen and pelvis to pinpoint your tumor and aim the beam at it. In another type of radiotherapy, doctors implant a small pellet or needle of radioactive material directly into your cancer. (This is rarely used for bladder cancer these days.)
When radiation is used alone or with chemotherapy, there is an increased likelihood that your other organs, such as the prostate and uterus, will remain functional, as does your ability to void urine normally and have sex. The intention when chemotherapy ^¿radiotherapy are given is usually to improve the chances of curing the cancer while preserving the bladder and avoiding the need to remove it surgically. This area is still somewhat controversial; some physicians believe that this approach is nearly as effective as surgical removal of the bladder, but others feel that cystectomy is the best treatment. The decision of which treatment to pursue depends in part upon the physical fitness of the patient as well as upon the patients personal preferences.
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Radiotherapy is not without side effects. Radiation can scar bladder tissue, and the scarring can reduce the amount of urine your bladder can hold as the bladder wall becomes less distensible. As a result you may experience an increase in the number of times you have to urinate, which can be irritating, especially at night. You also may experience an increase in bouts of cystitis.
There has been much discussion in the medical community about whether the results achieved by radiotherapy are the same as those from cystectomy with respect to achieving cure. We think that when one considers all types of bladder cancer, in the hands of a highly experienced urologist who specializes in this operation, cystectomy gives better results than radiotherapy. However, there are some patients, particularly those with other significant medical conditions, who will benefit from radiotherapy, despite the possibility of a lower chance of permanent cure. In some centers, such as Massachusetts General Hospital, where the techniques of chemo radio therapy and bladder preservation have been piloted, a urologist will perform a cystoscopy about halfway through the planned course of radiotherapy. If the tumor is shrinking well, radiotherapy will be completed. However, if it appears that the cancer is not responding to radiotherapy, the plan will be abandoned and replaced with a radical cystectomy.
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