Assessing lung cancer progression and survival with infrared spectroscopy of blood serum
Neoadjuvant Chemotherapy Plus Chemoradiation Safe, Effective In Bladder Cancer
For some patients with bladder cancer, neoadjuvant chemotherapy plus bladder-saving concurrent chemoradiation therapy was effective in the long term.
Neoadjuvant chemotherapy plus chemoradiation was safe and effective for long-term bladder preservation in select patients with muscle-invasive bladder cancer.
Among patients with nonmetastatic, muscle-invasive bladder cancer (MIBC), treatment with neoadjuvant cisplatin-based combination chemotherapy (NAC) plus bladder-saving concurrent chemoradiation therapy was effective and safe in the long term, according to findings presented at the 2025 ASCO Genitourinary Cancers Symposium.
Efficacy data revealed that after a median follow-up of 96 months, the median disease-free survival (DFS) in patients treated with NAC followed by CRT for nonmetastatic MIBC was 56.6 months, with a five-year DFS rate of 49.2%. Furthermore, the median bladder intact DFS (BI-DFS) in this patient group was 45.6 months, and the five-year BI-DFS was 47.6%. Additionally, the median overall survival (OS) was 105 months with a five-year OS rate of 62.2%.
"[Neoadjuvant, cisplatin-based chemotherapy plus] concurrent chemoradiotherapy is a safe and effective bladder-sparing approach with encouraging long-term outcomes in carefully selected patients with MIBC," Dr. Meghan E. Mahoney of the Division of Medical Oncology at the Tom Baker Cancer Centre in Calgary, Alberta, Canada, wrote in the presentation with study coinvestigators.
The study investigators contextualized the study background by highlighting a paucity of long-term data on the efficacy and tolerability of trimodality therapy in patients with MIBC opting for bladder-sparing approaches.
Glossary:Neoadjuvant: administered prior to the primary treatment, such as surgery.
Disease-free survival: the time after treatment that a patient lives without signs or symptoms of cancer.
Overall survival: the time that a patient lives, regardless of disease stats.
Maximal transurethral resection of a bladder tumor: the removal of a tumor through the urethra.
Cystoscopy: a procedure to examine the bladder and urethra.
Radical cystectomy: surgical removal of the bladder.
ECOG performance status: a way to measure patients' ability to complete daily tasks, with a lower number indicating greater independence.
Hydronephrosis: when the kidney becomes swollen due to a buildup of urine.
A total of 56 patients with nonmetastatic MIBC who were given NAC followed by bladder-sparing CRT between 2008 and 2017 at the Princess Margaret and Durham Regional Cancer Centers were included in the retrospective chart review. The primary outcomes were five-year DFS, BI-DFS and OS.
Patients initially underwent maximal transurethral resection of a bladder tumor (TURBT) prior to neoadjuvant treatment with gemcitabine plus cisplatin for two to four cycles. Following the second cycle of neoadjuvant treatment, imaging occurred in all patients, and those experiencing disease progression underwent cystoscopy before undergoing immediate radical cystectomy plus lymph node dissection. Furthermore, following the fourth cycle, all patients underwent imaging and cystoscopy, and those who experienced disease progression underwent maximal re-TURBT before undergoing immediate radical cystectomy plus lymph node dissection.
Responders to neoadjuvant treatment and those with stable disease were treated with external beam radiation therapy (EBRT) at a dose of 60 to 66 Gy to the bladder and pelvic lymph nodes, as well as concurrent weekly cisplatin at 40 mg/m2 for six weeks. Surveillance cystoscopy, imaging and urine cytology occurred after CRT every three to four months.
During the surveillance period, those with no recurrence continued surveillance. Additionally, those with non-MIBC recurrence repeated TURBT with or without Bacillus Calmette-Guerin treatment. Those with MIBC recurrence underwent salvage cystectomy. Furthermore, patients who experienced distant recurrence during the surveillance period were treated with systemic therapy.
Patients included in the analysis had a median age of 72 years and 79% were male. Additionally, 55% of patients had formerly smoked, with 20% of patients identifying as current smoking. Patients primarily had an ECOG performance status of 0 (66%) or 1 (32%). The median creatinine clearance was 59 mL/min, the median tumor size was 4.1 cm and 25% of patients had hydronephrosis.
Patients had clinical stage 2 (59%), 3 (34%), or 4 (7%) disease, and the most common histologies were pure urothelial carcinoma (UC; 63%), squamous UC (23%) and plasmacytoid variant UC (13%). A total of 30% and 18% of patients had carcinoma-in-situ and lymphovascular invasion, respectively. Overall, 41% of patients experienced disease recurrence, with 20% of patients experiencing local recurrence, 14% experiencing recurrence requiring cystectomy and 21% experiencing distant recurrence.
The primary NAC regimens were gemcitabine/cisplatin every 21 days (34%) or split gemcitabine/cisplatin every 21 days (57%). Overall, 5%, 32% and 63% of patients underwent two, three and four NAC cycles, with 95% of patients completing planned NAC treatment. The most common grade 3 (severe) or 4 (life-threatening) NAC-related toxicities included neutropenia (11%), thrombocytopenia (4%), infection (4%) and anemia (2%). NAC dose reductions occurred in 55% of patients with a median dose reduction percentage of 25%, and 39% of patients experienced NAC dose delays.
Additionally, the reasons for administering trimodality therapy included patient preference (59%), comorbidities related to radical cystectomy (36%) or some combination of both factors (4%). Most patients had a planned radiation therapy dose of 60 Gy or greater (91%), and all patients completed planned radiation. Furthermore, 86% of patients completed 60% or more of planned concurrent cisplatin dosing.
Reference:
"Long-term outcomes of neoadjuvant chemotherapy (NAC) before bladder-sparing chemoradiotherapy (CRT) for patients with nonmetastatic, muscle-invasive bladder cancer (MIBC)," by Dr. Meghan E. Mahoney, et al., Journal of Clinical Oncology.
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Meet Bladder Cancer Warrior Mike And His Wife And Care Partner, Heidi
© Johnson & Johnson and its affiliates 2025 02/25 cp-482994v1
Sponsored by Johnson & JohnsonWritten by Mike V.
Every patient's experience is unique and not representative of all patients.
Mike and Heidi are volunteers with the SHARE Network, a Johnson & Johnson program made up of people who are dedicated to inspiring others through their personal health journeys and stories of caring. Mike is a real patient and Heidi is his wife and care partner. They have been compensated by Johnson & Johnson for their time to develop this content. Every patient's experience is unique and not representative of all patients.
At 46, Mike—a husband, father of three, and assistant principal—knew something was wrong when his bathroom habits changed drastically. He tracked his frequent bathroom visits and memorized the quickest routes to restrooms, though he was often stopped by teachers or students along the way. His wardrobe shifted too, favoring comfort over formality by leaving his shirt untucked and wearing looser clothes.
Within a week, Mike and his wife, Heidi, a teacher, made an appointment with a urologist. Three months and many appointments and tests later, Mike finally got an answer: he had non-muscle-invasive bladder cancer (NMIBC).
Bladder cancer is the fourth most common cancer in males, but it's less common in females. It was estimated that more than 83,000 people would be diagnosed in the US in 2024.1 NMIBC is cancer found in the tissue that lines the inner surface of the bladder. The bladder muscle is not involved.2 NMIBC represents about 75% of new bladder cancer cases diagnosed in the United States in 2015.3
Mike's diagnosis came as a shock. He had no family history, wasn't a smoker, and was younger than the average patient—most are diagnosed after 55, with the average age of 73.1 While common risk factors include smoking, genetics, and chemical exposure, bladder cancer can happen to anyone.4
While NMIBC generally has a favorable survival prognosis, recurrence is common,3 and it can be sometimes difficult to treat. Mike soon learned that, in his case, his options were limited. The standard of care in certain kinds of bladder cancer treatment hasn't significantly changed in 40 years; the most common of which is a procedure called Bacillus Calmette-Guérin (BCG) therapy.5 Other treatments include chemotherapy, radiation, and surgery.6 There continues to be a need for additional treatment options.
Class Schedule: Journey to Diagnosis
Delays in diagnosis can worsen a patient's prognosis and limit their treatment options.7 Mike had to wait weeks between appointments, and more than four months passed before his treatment began.
Advocacy is important when patients are seeking a diagnosis. Throughout the process, Heidi became Mike's greatest advocate, learning everything she could about his condition and calling the cancer center daily to request an earlier appointment. Her persistence was eventually successful.
Seeking information, Mike turned, as most people in a new situation do, to the internet, starting with the Bladder Cancer Advocacy Network's (BCAN) website and podcast. He was a casual TikTok user, occasionally filming dance challenges or looking for recipes. He wanted to see what other people with bladder cancer were saying, but there wasn't much there. He decided to fill that gap by sharing his experience, speaking transparently about each step of his journey and hoping to help others.
Studying Up: Navigating Bladder Cancer Treatment
Mike makes informed decisions by having a trusted relationship with his treatment team while also educating himself and seeking second opinions when appropriate. His treatment began with six weeks of BCG therapy, a procedure where a modified version of the tuberculosis vaccine is inserted into the bladder via the urethra.8 Mike felt fortunate to avoid chemotherapy but wished he had more options.
The process is, as Mike puts it, "unpleasant and tiring."
In the summer, when teachers are typically off, Mike and Heidi had full-time jobs as patient and care partner. Later, Mike underwent surgery to remove his bladder tumors. This kept his family homebound, and family trips were put on hold. Mike and Heidi's teenage sons and Mike's father took turns helping with caregiving duties.
Heidi has been an unwavering partner and care partner, and Mike never forgets how fortunate he is to have her by his side. She's taken on his treatment plan as if it were her own and made it clear that Mike is not alone on this journey. Heidi even sought out additional training in wound and catheter care from a nurse friend to help keep Mike comfortable. Her proactive and nurturing approach has been a crucial part of his recovery.
Report Cards: Life A Year Later
Despite the uncertainty of the future, Mike and Heidi remain resilient. Known for their meticulous planning—whether it's lesson plans or theater trips—they've adopted a new mindset, taking things one step at a time.
Mike enjoys connecting with patients and care partners who watch his TikTok videos and has even been recognized in town as "the guy from TikTok!" He's talked to other patients from as far away as the United Kingdom—and as close to home as a former student, who commented warmly on one of his videos, "Of course you'd be here, helping other people." He's learned some exercises he can do to build his strength, and he feels his energy returning. He has found encouragement and camaraderie through Man Up to Cancer, a community that shares resources and encourages men living with cancer to connect with and support each other.
At Mike's most recent appointment, there was no evidence of disease, and his BCG treatment is scheduled to conclude in January 2025. There is light at the end of the tunnel.
Final Grades: Advice to Others Like Mike and Heidi
While this diagnosis has been a challenge, Mike and Heidi have emerged with wisdom and have learned patience, resilience, and how to accept cancelled plans. They have advice for others, too. Patients and care partners should advocate for themselves and push for answers from their healthcare providers. Finding—or creating—a community for support, whether in-person or virtual is critical; Mike is growing his following on TikTok at @mistervee3.
Above all, Mike and Heidi advise others to find their joy and hope. "We came through this as a family," Mike says. "We're stronger for it."
We partnered with Johnson & Johnson to share my story, raise awareness, and educate about bladder cancer. If you also have a story to share like mine, I hope you will consider joining the SHARE Network.
References:
Real-World Muscle-Invasive Bladder Cancer Treatment Patterns Revealed
Amid a rapidly evolving landscape in the treatment of muscle-invasive bladder cancer (MIBC), new findings presented at the 2025 ASCO Genitourinary Cancers Symposium in San Francisco, California, provide a real-world snapshot of how clinicians are using the latest therapies.
"Many patients did not receive neoadjuvant or adjuvant treatment, indicating a persistent unmet need in this patient population for alternative therapeutic regimens," John L. Gore, MD, MS, of the University of Washington School of Medicine in Seattle, and colleagues concluded in a study abstract.
Using the Inovalon claims database, the investigators identified 332 patients who underwent radical cystectomy from January 1, 2020 to December 31, 2021 and met other study inclusion criteria. The study population had a mean age of 64.3 years and was 73.8% male and 43.7% White. Of the 332 patients, 137 (41.3%) did not receive neoadjuvant therapy and 293 patients (88.3%) did not receive adjuvant therapy, Dr Gore's team reported.
Among the 195 patients (58.7%) who received neoadjuvant therapy, 153 (78.5%) received cisplatin-based therapy, most commonly cisplatin plus gemcitabine. Among the 39 patients (11.7%) who received adjuvant therapy, immunotherapy was the most common treatment (20 patients, or 51.3%) followed by chemotherapy with cisplatin (15 patients, or 38.5%).
The investigators also characterized the patient population and observed a high burden of comorbidities. Common comorbidities included hypertension (59.6%), urinary tract infection (28.3%), diabetes without chronic complications (26.5%), and chronic pulmonary disease (24.1%).
Astellas Pharma Inc. And Pfizer sponsored the research. Please see the original reference for a full list of disclosures.
References:
Gore JL, Shih V, Kelkar S, et al. Clinical characteristics and treatment patterns of patients with muscle invasive bladder cancer: A real-world cohort study. Presented at: ASCO GU 2025, February 13-15, San Francisco, California. Poster 698.
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