NHS updates bladder cancer chemotherapy guidelines

Hundreds of people with advanced bladder cancer across the UK can now receive three rather than six chemotherapy cycles following research by Queen Mary University of London which has led to a change to NHS treatment guidelines. For people with the condition, this means fewer toxic side effects and a better quality of life during treatment. 

Until recently, people with advanced bladder cancer routinely received between four to six cycles of intensive chemotherapy, followed by avelumab, a type of immunotherapy, as standard NHS care. While effective, this treatment can often cause severe side effects, including extreme fatigue, nausea, infections and long-term impacts on daily life. 

The international, investigator -led, randomized phase II DISCUS trial, published today in Annals of Oncology, sought to find out if giving patients fewer rounds of chemotherapy could help them survive just as long as current standard care, while causing fewer side effects and making treatment easier to cope with. 

The study included 267 people with advanced bladder cancer. Participants were allocated to receive either three cycles of chemotherapy, or the previous standard of six chemotherapy cycles, followed by avelumab. The study found that: 

• those who received three-cycles of chemotherapy reported their 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 who received fewer cycles of chemotherapy. 

As a result of this research, 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 and quality of life is expected to improve for hundreds of patients each year, reducing unnecessary side effects while maintaining the chance of controlling the disease. 

Lead author Thomas Powles, Professor of Genitourinary Oncology at Queen Mary University of London and Director of the Barts Cancer Centre at Barts Health NHS Trust, 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, Syed A Hussain, Professor of Medical Oncology and Honorary consultant, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust 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."