Individualizing Treatment for Asymptomatic Oligometastatic Bladder Cancer

What happens after chemotherapy?

• Patients with metastatic bladder cancer typically receive initial chemotherapy
• Whether those with asymptomatic oligometastatic cancer require additional local therapy remains an open question
• Treatment for this group of patients should be individualized

Chemotherapy is the generally recognized frontline treatment for metastatic bladder cancer. But for patients who are in the transitional oligometastatic state between localized and metastatic cancer and are asymptomatic, what comes next can be somewhat unclear.

“There are going to be patients that will get frontline chemotherapy and have a great response to treatment, with the tumor shrinking down or disappearing on scans,” Dr. Jeannie Hoffman-Censits, medical oncologist and bladder cancer specialist at Johns Hopkins, tells SurvivorNet Connect. Those patients who are asymptomatic can potentially go on a regimen of maintenance immunotherapy, she says.

The question is, would those patients do better with additional local therapy? It’s a complicated question, Dr. Hoffman-Censits says. “There’s somewhat of a reluctance to halt systemic therapy, to focus locally on a disease and run the risk of having the disease progress.” She says treatment for this unique patient population should be individualized with a multidisciplinary team decision-making process.