Actos Cancer Update
Actos Cancer: For invasive bladder cancer, chemotherapy is sometimes given before a cystectomy. Sometimes it is given afterward. Sometimes it is not given at all. It depends entirely on the type of tumor you have, where it may have spread, and whether you have another medical condition that might make it difficult for you to tolerate chemotherapy. Very advanced age can also be a factor in deciding whether chemotherapy is appropriate.
The choice of drugs used to treat invasive bladder cancer is similar to the choice in advanced or metastatic disease, and we will cover that in chapter 6. If you have invasive urothelial carcinoma, you will probably undergo chemotherapy, because this type of cancer is responsive to either radiotherapy or surgery with chemotherapy, and many studies have examined this type of cancer treatment. If you have been diagnosed with squamous cell cancer or adenocarcinoma, the outcome for chemotherapy is not so clearly defined. Most physicians don’t recommend chemotherapy as standard treatment in conjunction with cystectomy for these types of cancer. It is, however, quite reasonable for your team to suggest that you look into a clinical trial (e.g., one that is exploring the use of chemotherapy) if you have been diagnosed with squamous cell or adenocarcinoma.
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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.
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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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Actos Cancer