Hundreds of people with advanced bladder cancer across the UK can now receive three rather than six chemotherapy cycles after research involving Sheffield Teaching Hospitals NHS Foundation and the University of Sheffield led to a change to NHS treatment guidelines. For patients, this means fewer toxic side effects and a better quality of life during treatment.
Until recently, patients with advanced bladder cancer routinely received between four to six cycles of intensive chemotherapy as standard NHS care. While effective, this treatment often causes severe side effects, including extreme fatigue, nausea, infections and long-term impacts on daily life.
The international, investigator led, randomised phase II DISCUS trial, published in Annals of Oncology and led by Queen Mary University of London, sought to find out if giving patients less chemotherapy could keep them living just as long, while causing fewer side effects and making treatment easier to cope with.
The published results included 267 patients with advanced bladder cancer. Participants were allocated to received either three cycles of chemotherapy followed by avelumab, a type of immunotherapy, or the previous standard of six chemotherapy cycles. The study found that:
- Patients in the three-cycle group’s quality of life remained the same, while those in the six-cycle group reported a poorer quality of life.
- The median overall survival was the same for those undergoing three cycles and those undergoing six cycles.
- Severe side effects were less common in those undergoing the shorter chemotherapy cycle.
As a result, NHS guidelines have been updated, offering eligible patients a choice between three and six cycles of chemotherapy followed by maintenance avelumab. By halving the number of chemotherapy cycles, treatment is expected to improve for hundreds of patients each year, reducing unnecessary side effects while maintaining the chance of controlling the disease.
Sheffield Teaching Hospitals NHS Foundation Trust was the top recruiter to the large multinational trial, which recruited patients from across the UK, Spain and France.
Lead author Thomas Powles, Professor of Genitourinary Oncology at Queen Mary University of London and Director of the Barts Cancer Centre, said: “Fewer cycles of chemotherapy appear to improve quality of life without significantly compromising activity. This is particularly attractive for those patients who struggle with side effects.”
Second author, Professor Syed A Hussain, Honorary Consultant and Professor of Medical Oncology at Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield, said: “This update to NHS England guidance has the potential to benefit a significant proportion of patients, particularly those who discontinue chemotherapy after three cycles because of treatment-related toxicity.
“It is exciting to see that the DISCUS results have helped to change NHS England guidelines and patients can now be offered maintenance Avelumab treatment after three cycles of platinum-based chemotherapy,” Professor Hussain added.
